Healthcare Provider Details

I. General information

NPI: 1861888760
Provider Name (Legal Business Name): AJIT ALEXANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 19284
SHREVEPORT LA
71149-0284
US

IV. Provider business mailing address

PO BOX 19284
SHREVEPORT LA
71149-0284
US

V. Phone/Fax

Practice location:
  • Phone: 318-773-0657
  • Fax: 318-688-1559
Mailing address:
  • Phone: 318-773-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number320814
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number320814
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number320814
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number320814
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: