Individual
DR. BRANDON GAGE BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(601) 953-7160
Mailing address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(601) 953-7160
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2020
Last updated
05/06/2022
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