1194756437 NPI number — KARLA O QUERBES MD

Table of content: KARLA O QUERBES MD (NPI 1194756437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194756437 NPI number — KARLA O QUERBES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUERBES
Provider First Name:
KARLA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRETTIN
Provider Other First Name:
KARLA
Provider Other Middle Name:
NYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194756437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2551 GREENWOOD RD
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71103-3989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-621-2929
Provider Business Mailing Address Fax Number:
318-621-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2551 GREENWOOD ROAD
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-3989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-621-2929
Provider Business Practice Location Address Fax Number:
318-621-2930
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  021483 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD.021483 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00352890 . This is a "MEDICARE RR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 3186212930 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992909 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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