Basic Information
| Provider Information | |||||||||
| NPI: | 1396138756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR HENRY KISER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1684 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711651684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184244008 | ||||||||
| FaxNumber: | 3184246606 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 VIKING DR | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711112103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188412525 | ||||||||
| FaxNumber: | 3184258438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2015 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | KISER | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3184261094 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22656 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.