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General NPI Number Information
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NPI Number | 1376525295
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Entity Type | Individual
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Provider Name | ANN ELIZABETH BUBENZER MD
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 2226 WORLEY DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3600
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Country | US
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Telephone | 318-561-0003
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Fax | 318-561-0038
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Provider Business Mailing Address
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Address Line | 2226 WORLEY DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301
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Country | US
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Telephone | 318-561-0003
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Fax | 318-561-0038
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 15537R
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License Number State | LA
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