Organization
REGINA FAKNER, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGIAN FAKNER MD (OWNER)
(318) 226-4892
Entity
Organization
Contact information
Practice address
1801 FAIRFIELD AVE, SUITE 203, SHREVEPORT, LA 71101-4443
(318) 226-4892
(318) 227-4927
Mailing address
1801 FAIRFIELD AVE, SUITE 203, SHREVEPORT, LA 71101-4443
(318) 226-4892
(318) 227-4927
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11308R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1667145
—
LA
Enumeration date
11/22/2006
Last updated
10/08/2009
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