Organization
EAR NOSE & THROAT CENTER A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. W. JUAN WATKINS M.D. (PRESIDENT)
(318) 226-9441
Entity
Organization
Contact information
Practice address
2121 LINE AVE, SHREVEPORT, LA 71104-2126
(318) 226-9441
(318) 425-3236
Mailing address
2121 LINE AVE, SHREVEPORT, LA 71104-2126
(318) 226-9441
(318) 425-3236
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1122262
—
LA
Enumeration date
10/17/2006
Last updated
07/12/2007
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