Individual
DR. RYAN M WOLFORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71130
(318) 675-6111
Mailing address
812 COLUMBIA ST, SHREVEPORT, LA 71104
(318) 773-6863
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
200078
LA
208600000X
Surgery Physician
Primary
200078
LA
Other
Enumeration date
12/06/2006
Last updated
05/21/2021
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