=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033544465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BINOD POKHREL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2013
-----------------------------------------------------
Last Update Date | 08/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 OLIVE ST STE A
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71104-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-239-4860
-----------------------------------------------------
Fax | 318-588-8820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4506
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71134-0506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-239-4861
-----------------------------------------------------
Fax | 318-588-8820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD.302545
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------