RALPH JONATHAN HENDERSON (NPI# 1164427621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164427621 |
| Entity Type | Individual |
| Full Name | RALPH JONATHAN HENDERSON |
| Credential | M.D. |
| Practice Address |
255 Bert Kouns Shreveport LA 71106 |
| Mailing Address |
255 Bert Kouns Loop Shreveport LA 71106-8150 |
| Practice Telephone | 3186830411 |
| Practice Fax Number | 3186035461 |
| Mailing Telephone | 3186830411 |
| Mailing Fax Number | 3186035461 |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2010-04-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 021340 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1924075 | 05 | |
| LA | RAILROAD MEDICARE | 340019771 | 01 |
| Street Address |
255 BERT KOUNS |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417265851 | Brian Confrey Mazzarella | Urology | 255 Bert Kouns, Shreveport, LA 71106-8150 | 2010-09-20 |
| 1861717662 | Christopher Anthony Cefalu | Urology | 255 Bert Kouns, Shreveport, LA 71106-8150 | 2010-04-05 |
| 1396974382 | Ashley Sittig Baker | Urology | 255 Bert Kouns, Shreveport, LA 71106-8150 | 2009-07-10 |
| 1497750970 | James Lundy Moss | Urology | 255 Bert Kouns, Shreveport, LA 71106 | 2005-06-20 |
| 1457356933 | Mark Walter Callaway | Urology | 255 Bert Kouns, Shreveport, LA 71106 | 2005-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205208402 | Raymond Wendell Turner | Urology | 9854 Jennifer Ln, Shreveport, LA 71106-7716 | 2015-10-27 |
| 1427076777 | Donald Alan Elmajian | Urology | 8001 Youree Dr Ste 350, Shreveport, LA 71115-2326 | 2006-07-17 |
| 1902801467 | James Robert Noble | Urology | 255 Bert Kouns Loop, Shreveport, LA 71106-8150 | 2005-06-20 |
| 1013374222 | Lsu Health Sciences Center Shreveport Faculty Group Practice | Urology | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2016-01-19 |
| 1992194500 | Wk Urologic Cancer Care | Urology | 8001 Youree Dr, Suite 350, Shreveport, LA 71115-2302 | 2015-01-20 |
| 1801137906 | Wkp Arklatex Urology Clinic | Urology | 8001 Youree Dr, Suite 580, Shreveport, LA 71115-2302 | 2013-03-14 |
| 1164776290 | Wk Urology At Pierremont | Urology | 8001 Youree Dr, Suite 550, Shreveport, LA 71115-2302 | 2012-10-26 |
| 1407147291 | Andre Paul Broussard | Urology | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2011-04-27 |
| 1417265851 | Brian Confrey Mazzarella | Urology | 255 Bert Kouns, Shreveport, LA 71106-8150 | 2010-09-20 |
| 1861717662 | Christopher Anthony Cefalu | Urology | 255 Bert Kouns, Shreveport, LA 71106-8150 | 2010-04-05 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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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.