Healthcare Provider Details

I. General information

NPI: 1124010939
Provider Name (Legal Business Name): NORMAN A. ZAFFATER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 460
BOSSIER CITY LA
71111-1918
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 460
BOSSIER CITY LA
71111-1918
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-5838
  • Fax: 318-747-5827
Mailing address:
  • Phone: 318-747-5838
  • Fax: 318-747-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number10876R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: