Individual
DANIEL BRUCE HENNIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4550
Mailing address
PO BOX 9600, DEPT 09-033, TEXARKANA, TX 75505-9600
(877) 243-8416
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
015048
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1397041
—
LA
Enumeration date
02/01/2006
Last updated
02/03/2014
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