Healthcare Provider Details

I. General information

NPI: 1881969129
Provider Name (Legal Business Name): CLINT SUMBERA SCHOOLFIELD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE STE 401
KENNER LA
70065
US

IV. Provider business mailing address

604 FERRIDAY CT
HARAHAN LA
70123-7803
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-8588
  • Fax:
Mailing address:
  • Phone: 318-426-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD045086
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number308554
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: