Healthcare Provider Details

I. General information

NPI: 1295054930
Provider Name (Legal Business Name): FRANZ ALBERT OBUSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF INTERNAL MEDICINE
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF INTERNAL MEDICINE
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-5856
  • Fax: 318-675-8150
Mailing address:
  • Phone: 318-675-5856
  • Fax: 318-675-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number054507
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: