Healthcare Provider Details

I. General information

NPI: 1528300076
Provider Name (Legal Business Name): DAVID JUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 E BERT KOUN LOOP
SHREVEPORT LA
71105
US

IV. Provider business mailing address

1811 E BERT KOUN LOOP STE 430
SHREVEPORT LA
71105-5764
US

V. Phone/Fax

Practice location:
  • Phone: 318-424-8373
  • Fax:
Mailing address:
  • Phone: 318-424-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0087887
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberD87887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: