Individual
JERRY ELDON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8001 YOUREE DR, SHREVEPORT, LA 71115-2302
(318) 212-3500
(318) 212-3505
Mailing address
PO BOX 32600, SHREVEPORT, LA 71130-2600
(318) 212-4877
(318) 212-4192
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
12082R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1542334
—
LA
Enumeration date
08/17/2005
Last updated
03/20/2020
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