Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2991 | LA |
NPI | 1083702153 |
---|---|
Provider Name | Dr. Gary Stephen Key |
First Address | Shreveport, LA 71105-4701 |
Second Address | Shreveport, LA 71105-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 24/03/2015 |