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Organization

DP WYATT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
POWELL B AUER MD (OWNER)
(318) 990-9099
Entity
Organization

Contact information

Practice address
708 NORTH ASHLEY RIDGE LOOP BUILDING 400, SHREVEPORT, LA 71106
(318) 698-7000
(318) 698-7006
Mailing address
PO BOX 5237, SHREVEPORT, LA 71135-5237
(318) 798-4539

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1305171
LA
Enumeration date
05/06/2022
Last updated
05/06/2022
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