Individual
LEONARD TERRY MARTIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0177
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200825
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00612648
RR MEDICARE
GA
Enumeration date
06/01/2006
Last updated
02/27/2023
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