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NPI Code Detail

MEDICARE: DR. DREW RICHARD DETHLOFF MD

MEDICARE: DR. DREW RICHARD DETHLOFF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician351978LA

General Provider Information

NPI Number : 1518898972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DREW RICHARD DETHLOFF MD
Provider Business Mailing Address
First Line : PO BOX 33932
Second Line :
City : SHREVEPORT
State : LA
Zip : 71130-3932
Country : US
Telephone Number : 318-675-6111
Fax Number : 318-675-6138
Provider Business Practice Location Address
First Line : 1501 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-675-6111
Fax Number : 318-675-6138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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