Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 1974
NPI: 1578595997
Practice Locations (2)
212 RUSSELL BLVD
Nacogdoches, TX 759651237
212 RUSSELL BLVD
NACOGDOCHES, TX 759651237
9365699238
Source: CMS National Downloadable File, September 2026.