Organization
OVERTON BROOKS VA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYLON MALMAY BSRT (R) (T) (RADIATION THERAPIST)
(318) 332-1589
Entity
Organization
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
4855 AIRLINE DR APT 37D, BOSSIER CITY, LA 71111-6652
(318) 332-1589
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
—
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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