Healthcare Provider Details

I. General information

NPI: 1386634590
Provider Name (Legal Business Name): DOUGLAS E RIMMER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HOSPITAL DR STE 370
BOSSIER CITY LA
71111-2391
US

IV. Provider business mailing address

3217 MABEL ST
SHREVEPORT LA
71103-4022
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-9121
  • Fax: 318-549-0240
Mailing address:
  • Phone: 318-631-9121
  • Fax: 318-631-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number021631
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: