Healthcare Provider Details

I. General information

NPI: 1609867415
Provider Name (Legal Business Name): MAGDY ESKANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MAGDY SHEHATA MD

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 GREENWOOD RD
SHREVEPORT LA
71109-4635
US

IV. Provider business mailing address

9627 GARDERE DR
SHREVEPORT LA
71115-4603
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-4750
  • Fax: 318-212-8435
Mailing address:
  • Phone: 318-797-3635
  • Fax: 318-797-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD200836
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-4255
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD200836
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-4255
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD 200836
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: