Healthcare Provider Details

I. General information

NPI: 1871673111
Provider Name (Legal Business Name): JOHN ANTHONY VANCHIERE MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY # 5-303
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY # 5-303
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-6081
  • Fax: 318-675-6059
Mailing address:
  • Phone: 318-675-6081
  • Fax: 318-675-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberL6693
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD023912
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: