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Organization

RADIATION ONCOLOGY ASSOCIATES A MEDICAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SALLY EBRAHIM (ADMINISTRATOR)
(318) 222-1149
Entity
Organization

Contact information

Practice address
1 SAINT MARY PL, SHREVEPORT, LA 71101-4343
(318) 681-4126
(318) 425-2335
Mailing address
1800 BUCKNER ST, SUITE B100, SHREVEPORT, LA 71101-4440
(318) 222-1149
(318) 425-2335

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
08279R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1927911
LA
Enumeration date
04/19/2007
Last updated
08/22/2020
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