Healthcare Provider Details

I. General information

NPI: 1871689307
Provider Name (Legal Business Name): ALBERTO A SIMONCINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF RADIOLOGY
SHREVEPORT LA
71130
US

IV. Provider business mailing address

1512 W KIRBY PL
SHREVEPORT LA
71103-3822
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-5000
  • Fax: 318-675-5666
Mailing address:
  • Phone: 318-675-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number201091
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: