OB GYN ASSOCIATES OF SHREVEPORT (NPI# 1104034867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104034867 |
| Entity Type | Organization |
| Organization Name | OB GYN ASSOCIATES OF SHREVEPORT |
| Practice Address |
7941 Youree Dr Shreveport LA 71105-5538 |
| Practice Telephone | 3187977941 |
| Practice Fax Number | 3187977991 |
| Mailing Telephone | 3187977941 |
| Mailing Fax Number | 3187977991 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-02-04 |
| NPI Deactivation Date | 10/04/2017 |
| NPI Reactivation Date | 2019-02-04 |
| Authorized Official Name | DR. JOHN WALTER WATERFALLEN (PRESIDENT) |
| Authorized Official Telephone | 3187977941 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Street Address |
7941 YOUREE DR |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164417309 | John W Waterfallen | Obstetrics & Gynecology | 7941 Youree Dr, Shreveport, LA 71105-5538 | 2005-09-14 |
| 1851672968 | Kristen M Howard | Nurse Practitioner | 7941 Youree Dr, Shreveport, LA 71105-5538 | 2011-09-01 |
| 1700048980 | Erin Katherine Cassiere | Obstetrics & Gynecology | 7941 Youree Dr, Shreveport, LA 71105-5538 | 2008-06-27 |
| 1730174467 | Robert A Tucker | Obstetrics & Gynecology | 7941 Youree Dr, Shreveport, LA 71105-5538 | 2005-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033554738 | Melissa Fett Jordan | Obstetrics & Gynecology | 3100 Fairfield Ave, Unit 10a, Shreveport, LA 71104-4152 | 2013-05-08 |
| 1285984823 | Wk Ob-gyn Concepts | Obstetrics & Gynecology | 7853 Youree Dr, Shreveport, LA 71105-5505 | 2012-09-11 |
| 1609985381 | Marsha Friedrich | Obstetrics & Gynecology | 1801 Fairfield Avenue Ste 207, Shreveport, LA 71101 | 2006-08-29 |
| 1710956255 | Bradley C. Colvin | Obstetrics & Gynecology | 9111 Susan Dr, Shreveport, LA 71118-3136 | 2006-03-16 |
| 1164417309 | John W Waterfallen | Obstetrics & Gynecology | 7941 Youree Dr, Shreveport, LA 71105-5538 | 2005-09-14 |
| 1952306177 | Stephanie Ann Sockrider | Obstetrics & Gynecology | 8001 Youree Dr, Ste 900, Shreveport, LA 71115-2326 | 2005-06-15 |
| 1891181004 | Caitlin Favaloro Busada | Obstetrics & Gynecology | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2015-04-14 |
| 1689087355 | Wk Womens Specialists At South | Obstetrics & Gynecology | 2530 Bert Koun Loop, Suite 112, Shreveport, LA 71118-3132 | 2014-06-10 |
| 1629498902 | Lauren Deroche Harris | Obstetrics & Gynecology | 1501 Kings Hwy, Ob/gyn, Shreveport, LA 71103 | 2014-04-24 |
| 1952721946 | John Morgan | Obstetrics & Gynecology | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2014-04-17 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.