Provider Demographics
NPI:1164533030
Name:GLADNEY MARLER & ASSOCIATES ,LLC
Entity Type:Organization
Organization Name:GLADNEY MARLER & ASSOCIATES ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-795-9100
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 840
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2349
Mailing Address - Country:US
Mailing Address - Phone:318-795-9100
Mailing Address - Fax:318-795-9191
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 840
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2349
Practice Address - Country:US
Practice Address - Phone:318-795-9100
Practice Address - Fax:318-795-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08493R171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1698873Medicaid
LA5Y339Medicare PIN
LAG46935Medicare PIN