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General NPI Number Information
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NPI Number | 1295626893
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Entity Type | Individual
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Provider Name | MARJORIE BLOCHOUSSE MD
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Gender |
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 5400 E TEXAS ST
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City | BOSSIER CITY
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State | LA
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Zip | 71111-6906
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Country | US
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Telephone | 318-675-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 225 PIERREMONT RD
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City | SHREVEPORT
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State | LA
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Zip | 71105-4146
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Country | US
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Telephone | 318-497-9243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 348263
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License Number State | LA
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