MEDICARE: DONALD ALAN ELMAJIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	14020R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4A180F600	OTHER	LA	MEDICARE - PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427076777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD ALAN ELMAJIAN M.D.

Provider Business Mailing Address
First Line	:	1512 W KIRBY PL
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-3822
Country	:	US
Telephone Number	:	318-813-1200
Fax Number	:	318-813-1030

Provider Business Practice Location Address
First Line	:	8001 YOUREE DR STE 350
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2326
Country	:	US
Telephone Number	:	318-212-3369
Fax Number	:	318-212-3398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/24/2021

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