Healthcare Provider Details

I. General information

NPI: 1235337346
Provider Name (Legal Business Name): GREGORY C SAMPOGNARO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 BROADMOOR BLVD
MONROE LA
71201-2987
US

IV. Provider business mailing address

2503 BROADMOOR BLVD
MONROE LA
71201-2987
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-7726
  • Fax: 318-322-2614
Mailing address:
  • Phone: 318-322-7726
  • Fax: 318-322-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11645R
License Number StateLA

VIII. Authorized Official

Name: DR. GREGORY C SAMPOGNARO
Title or Position: MD
Credential: M.D.
Phone: 318-322-7726