Organization
APPLEGATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP ISHERWOOD MD (MEDICAL DIRECTOR)
(318) 742-0500
Entity
Organization
Contact information
Practice address
1605 BENTON RD, SUITE D, BOSSIER CITY, LA 71111-3578
(318) 742-0500
(318) 742-0588
Mailing address
1605 BENTON RD, SUITE D, BOSSIER CITY, LA 71111-3578
(318) 742-0500
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
04/24/2009
Last updated
06/04/2009
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