Provider Demographics
NPI:1245503119
Name:GENTRY HAUGHTON LLC
Entity type:Organization
Organization Name:GENTRY HAUGHTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENTRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-519-7555
Mailing Address - Street 1:PO BOX 5237
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-5237
Mailing Address - Country:US
Mailing Address - Phone:318-519-7555
Mailing Address - Fax:
Practice Address - Street 1:592 UNADILLA ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1240
Practice Address - Country:US
Practice Address - Phone:318-519-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200048213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty