MEDICARE: DR. ANSHUMAN JYOTI M.D.

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
1	2084P0800X	Psychiatry Physician	204139	LA
2	2084P0804X	Child & Adolescent Psychiatry Physician	204139	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740481506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANSHUMAN JYOTI M.D.

Provider Business Mailing Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 203
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3175
Country	:	US
Telephone Number	:	318-212-5871
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 203
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3175
Country	:	US
Telephone Number	:	318-212-5871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/05/2012

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