Basic Information
| Provider Information | |||||||||
| NPI: | 1427097930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOUD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CALEIST | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 MANSFIELD RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186293763 | ||||||||
| FaxNumber: | 3186293767 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 MANSFIELD RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186293763 | ||||||||
| FaxNumber: | 3186293767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO000012 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS8420 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | E-7954 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1239488 | 05 | LA | MEDICAID |