Organization
DELTA NEPHROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL G WHITE MD (OWNER)
(318) 226-0809
Entity
Organization
Contact information
Practice address
745 OLIVE ST, SUITE 200, SHREVEPORT, LA 71104-2246
(318) 226-0809
(318) 226-0812
Mailing address
PO BOX 1684, SHREVEPORT, LA 71165-1684
(318) 424-4008
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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