Healthcare Provider Details

I. General information

NPI: 1821027202
Provider Name (Legal Business Name): JEFFREY FRANK FOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 BERT KOUNS LOOP SUITE 6
SHREVEPORT LA
71118-3146
US

IV. Provider business mailing address

2514 BERT KOUNS LOOP SUITE 6
SHREVEPORT LA
71118-3146
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5966
  • Fax: 318-212-5963
Mailing address:
  • Phone: 318-212-5966
  • Fax: 318-212-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.018473
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number018473
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: