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Individual

JOHN G UNDERWOOD II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9091 ELLERBE RD, STE 200, SHREVEPORT, LA 71106-6738
(318) 681-1630
(318) 681-1632
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L03841
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1300675
LA
Enumeration date
03/23/2006
Last updated
03/07/2023
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