Organization
ARK LA TEX FOOT & ANKLE SPECIALISTS, LLC
Active
Other names
Ark La Tex Foot Specialists, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY W. BRYAN DPM (OWNER/MANAGER)
(318) 687-8447
Entity
Organization
Contact information
Practice address
385 BERT KOUNS, BLDG. 200, SHREVEPORT, LA 71106-8158
(318) 687-8447
(318) 687-9950
Mailing address
385 BERT KOUNS, BLDG. 200, SHREVEPORT, LA 71106-8158
(318) 687-8447
(318) 687-9950
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PD067R / PD207R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1706736
—
LA
01
—
DE9683
RR MEDICARE
LA
Enumeration date
07/01/2006
Last updated
02/27/2020
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