Healthcare Provider Details

I. General information

NPI: 1669413787
Provider Name (Legal Business Name): ROBERT L BARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 YOUREE DR
SHREVEPORT LA
71115-2302
US

IV. Provider business mailing address

PO BOX 4327
SHREVEPORT LA
71134-0327
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-3870
  • Fax:
Mailing address:
  • Phone: 318-222-1149
  • Fax: 318-425-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberL010967
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: