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Individual

TEDDY CARLO ALONSO AREVALO RODRIGUEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
347645
LA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
347645
LA
207RP1001X
Pulmonary Disease Physician
Primary
347645
LA

Other

Enumeration date
05/07/2019
Last updated
07/18/2025
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