Organization
SOUTH SHREVEPORT ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA WHEELER MD (PARTNER)
(318) 797-1743
Entity
Organization
Contact information
Practice address
1945 E 70TH ST, SUITE B, SHREVEPORT, LA 71105-5347
(318) 797-1743
Mailing address
PO BOX 52448, SHREVEPORT, LA 71135-2448
(318) 797-1743
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949337
—
LA
01
—
CI7153
RAIL ROAD MEDICARE
—
Enumeration date
05/22/2006
Last updated
11/17/2011
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