Individual
MR. SAM ANTHONY MEDICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
1310 NORTH HEARNE AVE, SHREVEPORT, LA 71107
(318) 676-5111
Mailing address
P O BOX 7904, SHREVEPORT, LA 71137-7904
(318) 676-5111
(318) 676-5021
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
LA
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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