Organization
DELTA MEDICAL PRACTICES, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GOODWIN GLADNEY JR. (MANAGER)
(318) 281-0078
Entity
Organization
Contact information
Practice address
510 S WASHINGTON ST, BASTROP, LA 71220-5033
(318) 556-3333
Mailing address
1523 TEXAS AVE, BASTROP, LA 71220-4043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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