Provider Demographics
NPI:1689783342
Name:GURWARA, DHARAM (MD)
Entity Type:Individual
Prefix:
First Name:DHARAM
Middle Name:
Last Name:GURWARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5027
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5027
Mailing Address - Country:US
Mailing Address - Phone:318-686-5255
Mailing Address - Fax:318-752-2890
Practice Address - Street 1:6821 PINES RD STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2547
Practice Address - Country:US
Practice Address - Phone:318-686-5255
Practice Address - Fax:318-686-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017034208100000X
LA0171342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900885Medicaid
LA53725Medicare PIN
LA1900885Medicaid