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Individual

DR. CHARLES GODFRIED OTU-NYARKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
2508 BERT KOUNS LOOP, SUITE 101, SHREVEPORT, LA 71118-3133
(318) 212-5858
(318) 212-5877
Mailing address
2508 BERT KOUNS LOOP, SUITE 101, SHREVEPORT, LA 71118-3133
(318) 212-5858
(318) 212-5877

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125.052705
IL
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD.203819
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2107259
LA
Enumeration date
08/19/2008
Last updated
05/14/2021
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