Individual
GREGORY PHILLIP WELLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2915 MISSOURI AVE, SHREVEPORT, LA 71109-4327
(318) 621-8820
(318) 364-2090
Mailing address
PO BOX 731280, DALLAS, TX 75373-1280
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
025739
LA
Other
Enumeration date
06/06/2006
Last updated
04/11/2012
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