Individual
DR. GARY BERNARD MAZZANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 JORDAN ST, SUITE A, SHREVEPORT, LA 71101-4660
(318) 221-6700
(318) 221-6701
Mailing address
701 JORDAN ST, SUITE A, SHREVEPORT, LA 71101-4660
(318) 221-6700
(318) 221-6701
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
MD020779
LA
207Q00000X
Family Medicine Physician
MD020779
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1399256
—
LA
Enumeration date
09/16/2006
Last updated
12/01/2009
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