Healthcare Provider Details

I. General information

NPI: 1336381458
Provider Name (Legal Business Name): CAO CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST STE 408
SHREVEPORT LA
71105-2413
US

IV. Provider business mailing address

2924 KNIGHT ST STE 408
SHREVEPORT LA
71105-2413
US

V. Phone/Fax

Practice location:
  • Phone: 318-734-7797
  • Fax:
Mailing address:
  • Phone: 318-734-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number201161
License Number StateLA

VIII. Authorized Official

Name: MANDY LYNN BROUDREAUX
Title or Position: PRESIDENT
Credential: MD
Phone: 318-734-7797