Healthcare Provider Details

I. General information

NPI: 1679653331
Provider Name (Legal Business Name): SCOTT F CASSINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 THORA BLVD
SHREVEPORT LA
71106-1519
US

IV. Provider business mailing address

833 THORA BLVD
SHREVEPORT LA
71106-1519
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-4331
  • Fax:
Mailing address:
  • Phone: 318-868-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number016818
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: