Healthcare Provider Details

I. General information

NPI: 1942248349
Provider Name (Legal Business Name): JULIA A ELROD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT MARY PL
SHREVEPORT LA
71101-4343
US

IV. Provider business mailing address

1 SAINT MARY PL
SHREVEPORT LA
71101-4343
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-6653
  • Fax:
Mailing address:
  • Phone: 318-681-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number08983R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: