Basic Information
Provider Information
NPI: 1578875084
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PANT
FirstName: ALOK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1512 W KIRBY PL
Address2:  
City: SHREVEPORT
State: LA
PostalCode: 711033822
CountryCode: US
TelephoneNumber: 3186755000
FaxNumber:  
Practice Location
Address1: 1501 KINGS HWY
Address2:  
City: SHREVEPORT
State: LA
PostalCode: 711034228
CountryCode: US
TelephoneNumber: 3186755000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/13/2010
LastUpdateDate: 08/26/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD.206469LAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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