Individual
DR. RALPH WILLARD BAUCUM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1453 E BERT KOUN LOOP, STE 112, SHREVEPORT, LA 71105-6800
(318) 222-3695
(318) 424-0717
Mailing address
PO BOX 51008, SHREVEPORT, LA 71135-1008
(318) 798-9400
(318) 213-7276
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
019833
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1996076
—
LA
Enumeration date
07/26/2005
Last updated
01/30/2017
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