Individual
MR. DEWAYNE BRICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1460 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5644
(318) 797-2955
Mailing address
417 CREEK HOLW, SHREVEPORT, LA 71115-3739
(318) 453-1879
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 03866
TX
363A00000X
Physician Assistant
Primary
PA.A10376.RX
LA
Other
Enumeration date
10/04/2006
Last updated
04/26/2013
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