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NPI Code Detail

MEDICARE: DR. BRIAN L DOCKENDORF MD

MEDICARE: DR. BRIAN L DOCKENDORF MD
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
1208600000XSurgery Physician09794RLA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11053315846OTHERLAGROUP MEDICARE NUMBER
2020025718OTHERLARAILROAD MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598769432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN L DOCKENDORF MD
Provider Business Mailing Address
First Line : 1455 E BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5634
Country : US
Telephone Number : 318-798-4600
Fax Number : 318-798-4412
Provider Business Practice Location Address
First Line : 1455 E BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5634
Country : US
Telephone Number : 318-798-4600
Fax Number : 318-798-4412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 12/11/2020

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Directions to “ DR. BRIAN L DOCKENDORF MD” Practice Location

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