Individual
MR. LUGENE DAVIS IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4405 AIRLINE DR, BOSSIER CITY, LA 71111-2058
(318) 741-1196
Mailing address
8934 TAYLOR LN, SHREVEPORT, LA 71129-4353
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4803
LA
Other
Enumeration date
01/22/2012
Last updated
01/22/2012
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