| Danzell Family Medical Clinic | |
|
2500 Kings Hwy Shreveport LA 71103-3922 | |
| (318) 631-4030 | |
| (318) 631-4031 |
| Full Name | Danzell Family Medical Clinic |
|---|---|
| Speciality | General Practice |
| Location | 2500 Kings Hwy, Shreveport, Louisiana |
| Authorized Official Name and Position | John Davis Danzell (MEDICAL DOCTOR) |
| Authorized Official Contact | 3186314030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Danzell Family Medical Clinic 2500 Kings Hwy Shreveport LA 71103-3922 Ph: (318) 631-4030 | Danzell Family Medical Clinic 2500 Kings Hwy Shreveport LA 71103-3922 Ph: (318) 631-4030 |
| NPI Number | 1134548175 |
|---|---|
| Provider Enumeration Date | 04/07/2014 |
| Last Update Date | 04/07/2014 |
| Medicare PECOS PAC ID | 7719208453 |
|---|---|
| Medicare Enrollment ID | O20150605000986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134548175 | NPI | - | NPPES |
| 1307891 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 013603 (Louisiana) | Primary |
| Provider Name | John D Danzell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821173535 PECOS PAC ID: 9537345491 Enrollment ID: I20120516000706 |
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