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Organization

BONE & JOINT CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. WAYNE SMITH MANAGER (ADMINISTRATOR)
(318) 425-8701
Entity
Organization

Contact information

Practice address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 425-8701
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 425-8701

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
09700
LA

Other

Enumeration date
08/29/2006
Last updated
08/22/2020
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