DR. RALPH WILLARD BAUCUM III (NPI# 1295735793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295735793 |
| Entity Type | Individual |
| Full Name | DR. RALPH WILLARD BAUCUM III |
| Credential | M.D. |
| Practice Address |
1453 E Bert Koun Loop Ste 112 Shreveport LA 71105-6800 |
| Mailing Address |
Po Box 51008 Shreveport LA 71135-1008 |
| Practice Telephone | 3182223695 |
| Practice Fax Number | 3184240717 |
| Mailing Telephone | 3187989400 |
| Mailing Fax Number | 3182137276 |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2017-01-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
019833 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1996076 | 05 |
| Street Address |
1453 E BERT KOUN LOOP STE 112 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-6800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588664080 | William Howard Haynie Jr. | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2005-07-26 |
| 1881127090 | Advanced Cardiovascular Specialists | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2017-04-05 |
| 1508315342 | Scott Anthony Leblanc | Physical Therapist | 1453 E Bert Koun Loop, Shreveport, LA 71105-6800 | 2016-09-21 |
| 1700259678 | Highland Clinic, A Prof Med Corp | Orthopaedic Surgery | 1453 E Bert Koun Loop, #210, Shreveport, LA 71105-6800 | 2015-11-02 |
| 1851681217 | John Michael Evans | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1453 E Bert Koun Loop, Shreveport, LA 71105-6800 | 2011-04-19 |
| 1093715591 | Albert Nolen Krause | Internal Medicine | 1453 E Bert Koun Loop, Suite 112, Shreveport, LA 71105-6800 | 2005-07-26 |
| 1184624686 | Michael Henry Gooszen | Internal Medicine | 1453 E Bert Koun Loop, Suite 112, Shreveport, LA 71105-6800 | 2005-07-26 |
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104281476 | White Clover, LLC | Internal Medicine | 8835 Line Ave Ste 400, Shreveport, LA 71106-6730 | 2015-12-30 |
| 1831331842 | Vieux Carre Investments, LLC | Internal Medicine | 8730 Youree Dr Ste B, Shreveport, LA 71115-2518 | 2009-04-06 |
| 1184720393 | Joseph L. Fredi | Internal Medicine | 1811 E Bert Kouns Industrial Loop Ste 210, Shreveport, LA 71105 | 2006-09-15 |
| 1255321881 | Michael Glen Walton | Internal Medicine | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3917 | 2005-10-25 |
| 1760472419 | Paul Corkran Davis | Internal Medicine | 1453 E Bert Koun Loop Ste 112, Shreveport, LA 71105-6810 | 2005-10-25 |
| 1801886585 | Robert Tate Martin | Internal Medicine | 1811 E Bert Kouns Industrial Loop # 210, Shreveport, LA 71105 | 2005-10-25 |
| 1669472155 | Sanders Fowler Hearne | Internal Medicine | 1811 E Bert Kouns, Suite 100, Shreveport, LA 71115 | 2005-07-26 |
| 1588664080 | William Howard Haynie Jr. | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2005-07-26 |
| 1881127090 | Advanced Cardiovascular Specialists | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2017-04-05 |
| 1972043511 | Wk Heart and Vascular Institute Chf Clinic | Internal Medicine | 2727 Hearne Ave, Shreveport, LA 71103-3917 | 2017-03-01 |
| 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.