Individual
RUSSELL SHANE CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 400, SHREVEPORT, LA 71105-5740
(318) 212-3810
(318) 212-3815
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 400, SHREVEPORT, LA 71105-5740
(318) 212-3810
(318) 212-3815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12951R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1556581
—
LA
Enumeration date
02/22/2006
Last updated
06/21/2021
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