Healthcare Provider Details

I. General information

NPI: 1003295791
Provider Name (Legal Business Name): BADER ALOTAIBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 10/23/2023
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HEARNE AVE STE 301
SHREVEPORT LA
71103-3918
US

IV. Provider business mailing address

2727 HEARNE AVE STE 301
SHREVEPORT LA
71103-3918
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-6400
  • Fax:
Mailing address:
  • Phone: 318-631-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number337761
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number337761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: