Doctor Name: | DR. GAVIN F CHICO |
NPI Number: | 1740261650 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M. D. |
License Number: | 11956R |
Business Practice Address: | 1633 Marvel St Coushatta, LA - 710199022 |
Business Phone Number: | 3189322081 |
Business Fax Number: | 3189322215 |
Mailing Address: | Po Box 53032, SHREVEPORT |
State: | LA |
Postal Code: | 711353032 |
Phone Number: | 3189322081 |
Fax Number: | 3189322215 |
NPI Enumeration Date: | 11/08/2005 |
NPI Last Update Date: | 12/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 11956R |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |