Organization
SHREVEPORT ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY ALLEN MD (PRESIDENT)
(318) 635-4269
Entity
Organization
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(972) 664-6900
Mailing address
9441 LBJ FWY STE 400, DALLAS, TX 75243-4500
(972) 664-6963
(770) 237-4731
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949124
—
LA
01
—
CE9481
RAILROAD MEDICARE
LA
Enumeration date
12/14/2006
Last updated
04/14/2008
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