Healthcare Provider Details

I. General information

NPI: 1770587537
Provider Name (Legal Business Name): IRENE SCALTSAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 DRU CIR
SHREVEPORT LA
71106-2311
US

IV. Provider business mailing address

417 DRU CIR
SHREVEPORT LA
71106-2311
US

V. Phone/Fax

Practice location:
  • Phone: 318-423-1048
  • Fax:
Mailing address:
  • Phone: 318-423-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11943R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: