Individual
DR. PHILIP J GARAVAGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 BUCKNER ST, SUITE C120, SHREVEPORT, LA 71101-4440
(318) 227-8899
(318) 425-3793
Mailing address
1800 BUCKNER ST, SUITE C120, SHREVEPORT, LA 71101-4440
(318) 227-8899
(318) 425-3793
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
07284R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1364975
—
LA
01
—
721404303GA1
OCHSNER
LA
01
—
A008
CHAMPUS
—
Enumeration date
09/20/2005
Last updated
07/08/2007
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