Healthcare Provider Details

I. General information

NPI: 1275742470
Provider Name (Legal Business Name): JULIE A CUPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A GUIDROZ M.D.

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 YOUREE DR
SHREVEPORT LA
71105-5505
US

IV. Provider business mailing address

7843 YOUREE DR
SHREVEPORT LA
71105-5505
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-3772
  • Fax: 318-212-3773
Mailing address:
  • Phone: 318-212-3772
  • Fax: 318-212-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR7857
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2014-00152
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberP6366
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number303750
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: