Ofundem Rose Gwan, MD
General Practice in Ruston, LA. Individual provider (NPI-1).
NPI number1245440940
StatusActive
Last updated in NPPESJan 23, 2023
Details
- NPI
- 1245440940
- Entity type
- Individual (NPI-1)
- Name
- Ofundem Rose Gwan
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 23, 2007
- Certification date
- Jan 23, 2023
- Last updated
- Jan 23, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | MD.203609 | LA | Yes |
| 207R00000X | Internal Medicine | MD.203609 | LA |
Practice location
1406 S Vienna StRuston, LA 71270-6428
Phone 318-232-2456 · Fax 318-232-2457
Mailing address
282 John Wayne DrLafayette, LA 70508-4918
Phone 337-371-9670 · Fax 318-232-2457
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