Individual
KENNETH JAMES MANAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF MEDICINE GASTROENTEROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2528
(318) 813-2565
Mailing address
1501 KINGS HWY, DEPARTMENT OF MEDICINE GASTROENTEROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2528
(318) 813-2565
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
06583R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1354848
—
LA
Enumeration date
07/16/2006
Last updated
06/19/2008
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