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General NPI Number Information
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NPI Number | 1598769432
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Entity Type | Individual
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Provider Name | BRIAN L DOCKENDORF MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 1455 E BERT KOUNS LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105-5634
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Country | US
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Telephone | 318-798-4600
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Fax | 318-798-4412
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Provider Business Mailing Address
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Address Line | 1455 E BERT KOUNS LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105-5634
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Country | US
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Telephone | 318-798-4600
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Fax | 318-798-4412
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 09794R
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License Number State | LA
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