Healthcare Provider Details

I. General information

NPI: 1508863556
Provider Name (Legal Business Name): PAULA E REMBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 01/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E BERT KOUNS LOOP SUITE 221
SHREVEPORT LA
71105-6800
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-4766
  • Fax: 318-795-4763
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD018978
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: