Organization
RED RIVER ARMY DEPOT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TROY ROSS M.D. (CHIEF MEDICAL OFFICER)
(903) 334-2155
Entity
Organization
Contact information
Practice address
9403 EVERGREEN DR, SHREVEPORT, LA 71118-3935
(318) 393-2243
Mailing address
9403 EVERGREEN DRIVE, SHREVEPORT, LA 71118
(318) 393-2243
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
13698
OK
Other
Enumeration date
05/31/2007
Last updated
08/22/2020
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