Healthcare Provider Details

I. General information

NPI: 1427097930
Provider Name (Legal Business Name): JOHN CALEIST SOUD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 MANSFIELD RD STE 110
SHREVEPORT LA
71118-3137
US

IV. Provider business mailing address

9300 MANSFIELD RD STE 110
SHREVEPORT LA
71118-3137
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-3763
  • Fax: 318-629-3767
Mailing address:
  • Phone: 318-629-3763
  • Fax: 318-629-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS8420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO000012
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-7954
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: