LARRY K BROADWELL (NPI# 1326194036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326194036 |
| Entity Type | Individual |
| Full Name | LARRY K BROADWELL |
| Credential | MD |
| Practice Address |
820 Jordan St Suite 201 Shreveport LA 71101-4518 |
| Practice Telephone | 3182210399 |
| Practice Fax Number | 3182211940 |
| Mailing Telephone | 3182210399 |
| Mailing Fax Number | 3182211940 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-11-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
013598 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1303429 | 05 |
| Street Address |
820 JORDAN ST SUITE 201 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235139098 | Red River Orthotic Specialists, LLC | Prosthetic/Orthotic Supplier | 820 Jordan St, Suite 110, Shreveport, LA 71101-4518 | 2005-07-22 |
| 1396269171 | Ulissa Samone Edwards | Counselor | 820 Jordan St, Shreveport, LA 71101-4518 | 2017-08-02 |
| 1154845196 | Kelvin Wayne Latson | Counselor | 820 Jordan St, Shreveport, LA 71101-4518 | 2017-08-01 |
| 1033633201 | Monica Burns | Counselor | 820 Jordan St, Ste. 507, Shreveport, LA 71104 | 2017-07-31 |
| 1811410376 | Aaliyah Janee' Watkins | Counselor | 820 Jordan St, Shreveport, LA 71101-4518 | 2017-07-17 |
| 1275983363 | Morris Crichlow | Counselor | 820 Jordan St, Suite 204, Shreveport, LA 71101-4518 | 2016-06-20 |
| 1730536202 | Innerlight Wellness, LLC | Counselor | 820 Jordan St, Suite 204, Shreveport, LA 71101-4518 | 2016-05-15 |
| 1548661440 | Tiffany Alyce Roe | Nurse Practitioner | 820 Jordan St, Suite 201, Shreveport, LA 71101-4518 | 2014-09-10 |
| 1861812307 | Carol Hamilton Brill | Counselor | 820 Jordan St, Suite 510-c, Shreveport, LA 71101-4518 | 2014-04-23 |
| 1659701209 | Latoya Houston | Nurse Practitioner | 820 Jordan St, Suite 501, Shreveport, LA 71101-4518 | 2013-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962794404 | Louisiana Arthritis and Rheumatology,llc | Internal Medicine | 457 Ashley Ridge Blvd Ste C, Shreveport, LA 71106-7229 | 2011-05-03 |
| 1235349580 | Mary Katherine Walton | Internal Medicine | 820 Jordan St Ste 201, Shreveport, LA 71101-4518 | 2007-05-23 |
| 1013132653 | Kyla Lokitz | Internal Medicine | 8508 Line Ave Ste C, Shreveport, LA 71106-6131 | 2007-04-17 |
| 1477639565 | Susan Vanhook Williams | Internal Medicine | 437 Dunmoreland Cir, Shreveport, Shreveport, LA 71106-6101 | 2006-10-31 |
| 1396197216 | Rina Musa | Internal Medicine | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2016-07-02 |
| 1629429733 | Ahmad Qurie | Internal Medicine | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2016-06-29 |
| 1255719696 | Harman Fervaha | Internal Medicine | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2015-05-18 |
| 1023300910 | Haidy Ibrahim Gohar Galous | Internal Medicine | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2011-05-10 |
| 1902110109 | Mamatha Katikaneni | Internal Medicine | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2010-07-29 |
| 1851554786 | Aaron Wilton Broadwell | Internal Medicine | 820 Jordan St, Suite 201, Shreveport, LA 71101-4518 | 2008-07-10 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on LARRY K BROADWELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.