Healthcare Provider Details

I. General information

NPI: 1215943642
Provider Name (Legal Business Name): SANFORD RORY KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 KINGS HWY
SHREVEPORT LA
71103-3950
US

IV. Provider business mailing address

PO BOX 30015
SHREVEPORT LA
71130-0015
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-4639
  • Fax: 318-212-8305
Mailing address:
  • Phone: 318-212-4639
  • Fax: 318-212-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12437R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number12437R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: