Individual
DR. CHARLES K BURLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
114937
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
MD.022218
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203834015
—
MO
Enumeration date
06/05/2006
Last updated
02/17/2023
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