Individual
OFUNDEM ROSE GWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1406 S VIENNA ST, RUSTON, LA 71270-6428
(318) 232-2456
(318) 232-2457
Mailing address
282 JOHN WAYNE DR, LAFAYETTE, LA 70508-4918
(337) 371-9670
(318) 232-2457
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.203609
LA
208D00000X
General Practice Physician
Primary
MD.203609
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1459330
—
LA
Enumeration date
05/23/2007
Last updated
01/23/2023
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