Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER VIRAL DISEASE CLINI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT PENN MD (MEDICAL DIRECTOR)
(318) 798-5930
Entity
Organization
Contact information
Practice address
6670 SAINT VINCENT AVE, SHREVEPORT, LA 71106-2638
(318) 862-9986
Mailing address
1821 BAYOU DR, SHREVEPORT, LA 71105-3403
(318) 865-2578
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1697770
—
LA
Enumeration date
08/09/2005
Last updated
08/22/2020
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