Provider Demographics
NPI:1821054214
Name:GLADNEY, JOHN DAVIDSON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVIDSON
Last Name:GLADNEY
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 1:8001 YOUREE DRIVE
Mailing Address - Street 2:SUITE 840
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-795-9100
Mailing Address - Fax:318-222-8889
Practice Address - Street 1:8001 YOUREE DRIVE
Practice Address - Street 2:SUITE 840
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-795-9100
Practice Address - Fax:318-222-8889
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL015042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1362395Medicaid
LA1362395Medicaid
LA51294CX69Medicare PIN
LAB62949Medicare UPIN