MEDICARE: DR. JEREMY LOUISSAINT 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	207RG0100X	Gastroenterology Physician	T6952	TX
2	207R00000X	Internal Medicine Physician	2015017601	MO
3	207RG0100X	Gastroenterology Physician	308785-01	NY

General Provider Information

NPI Number	:	1700267879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY LOUISSAINT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-3720
Country	:	US
Telephone Number	:	214-633-5555
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	08/01/2022

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