Organization
BLUEFIN MEDICAL, LLC
Active
Parent organization
BLUE MEDICAL, LLC
Other names
BlueFin Recovery
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLUE MEDICAL, LLC
Authorized official
DR. RANDALL IVAN DAVIS MD (CEO)
(318) 773-5880
Entity
Organization
Contact information
Practice address
850 MARGARET PL, SHREVEPORT, LA 71101-4521
(318) 208-2000
(318) 227-7627
Mailing address
850 MARGARET PL, SHREVEPORT, LA 71101-4521
(318) 208-2000
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486647
—
LA
Enumeration date
12/01/2022
Last updated
12/01/2022
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