Healthcare Provider Details

I. General information

NPI: 1245237742
Provider Name (Legal Business Name): REGIONAL UROLOGY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 BERT KOUNS LOOP
SHREVEPORT LA
71106-8150
US

IV. Provider business mailing address

255 BERT KOUNS LOOP
SHREVEPORT LA
71106-8150
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-0411
  • Fax: 318-603-5461
Mailing address:
  • Phone: 318-683-0411
  • Fax: 318-603-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. RAYMOND D GERMANY JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 318-683-0411