Individual
LANE RANDALL ROSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 KINGS HWY, SHREVEPORT, LA 71103-3950
(318) 212-4639
(318) 212-8305
Mailing address
PO BOX 30015, SHREVEPORT, LA 71130-0015
(318) 212-4639
(318) 212-8305
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
022004
LA
2085R0202X
Diagnostic Radiology Physician
022004
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1697192
—
LA
Enumeration date
07/20/2006
Last updated
12/18/2007
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