Organization
GERIATRIC MEDICAL CORPORATION
Active
Organization
GERIATRIC MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID T HENRY M.D. (PHYSICIAN)
(318) 212-3830
Entity
Organization
Contact information
Practice address
7813 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-3830
(318) 212-3835
Mailing address
1300 GRIMMETT DR, SHREVEPORT, LA 71107-6502
(318) 212-3830
(318) 212-3835
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
L010682
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1096156
—
LA
Enumeration date
09/08/2008
Last updated
09/08/2008
Update your record
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