Healthcare Provider Details

I. General information

NPI: 1134131501
Provider Name (Legal Business Name): CHARN NOPAJAROONSRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax: 318-424-6093
Mailing address:
  • Phone: 318-221-8411
  • Fax: 318-424-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number6013
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: