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Individual

LUSTER BAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1513 DEBRA ST, BOSSIER CITY, LA 71111-3319
(318) 676-8096
Mailing address
1513 DEBRA ST, BOSSIER CITY, LA 71111-3319
(318) 676-8096

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
007443587
DRIVERS LICENSE
LA
Enumeration date
11/08/2016
Last updated
11/08/2016
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