Individual
JEFFREY DALE LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
451 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 222-5555
(318) 222-6414
Mailing address
451 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 222-5555
(318) 222-6414
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
204196
LA
207W00000X
Ophthalmology Physician
P6997
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/14/2009
Last updated
07/08/2014
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