Individual
DR. JOHN V. MARYMONT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF ORTHOPEDICS, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-7636
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
203714
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2110080
—
LA
01
—
4P025F600
MEDICARE - PTAN
LA
Enumeration date
10/17/2006
Last updated
07/26/2012
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