Individual
DR. GAVIN F CHICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1633 MARVEL ST, COUSHATTA, LA 71019-9022
(318) 932-2081
(318) 932-2215
Mailing address
PO BOX 53032, SHREVEPORT, LA 71135-3032
(318) 932-2081
(318) 932-2215
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11956R
LA
207P00000X
Emergency Medicine Physician
11956R
LA
207R00000X
Internal Medicine Physician
Primary
11956R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699799
—
LA
01
—
P00814514
RR MEDICARE NUMBER
LA
Enumeration date
11/08/2005
Last updated
03/17/2021
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