Provider Demographics
NPI:1639331283
Name:DHARAM P GURWARA APMC
Entity type:Organization
Organization Name:DHARAM P GURWARA APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHARAM
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:GURWARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-752-2890
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:318-752-2890
Mailing Address - Fax:318-752-2890
Practice Address - Street 1:6047 FIVE OAKS DR
Practice Address - Street 2:SUITE D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2596
Practice Address - Country:US
Practice Address - Phone:318-752-2890
Practice Address - Fax:318-752-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017034208100000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900885Medicaid
LAE10324Medicare UPIN
LA53725Medicare PIN