Individual
DAKOTA BOSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 480, SHREVEPORT, LA 71105-5765
(318) 212-2810
(318) 212-2818
Mailing address
2449 HOSPITAL DR STE 400, BOSSIER CITY, LA 71111-1914
(182) 127-9023
(318) 212-7905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.307727
LA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD.307727
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2387928
—
LA
Enumeration date
04/17/2015
Last updated
07/12/2022
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