Healthcare Provider Details

I. General information

NPI: 1467896738
Provider Name (Legal Business Name): MARY M ESKANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 MILLICENT WAY
SHREVEPORT LA
71115-5207
US

IV. Provider business mailing address

8383 MILLICENT WAY
SHREVEPORT LA
71115-5207
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-6661
  • Fax: 318-795-8512
Mailing address:
  • Phone: 318-797-6661
  • Fax: 318-795-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303134
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: