Individual
DR. JOHNNIE M. EMANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2915 MISSOURI AVE, SHREVEPORT, LA 71109-4327
(318) 364-2000
Mailing address
PO BOX 9600, DEPT. 09-021, TEXARKANA, TX 75505-9600
(318) 868-0932
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
008628
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1099384
—
LA
Enumeration date
10/10/2005
Last updated
10/15/2007
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