| Organization Name: | SHREVEPORT FAMILY MEDICINE INC |
| NPI Number: | 1003975079 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHELIA L. JACKSON (ADMINISTRATOR) |
| Mailing Address: | 7505 Pines Road Suite 1250 Shreveport |
| State: | LA US |
| Postal Code: | 711293927 |
| Phone Number: | 3186863770 |
| Fax Number: | 3186863838 |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 06/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |