Individual
DR. JIBIN SAM MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
324800
LA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
324800
LA
Other
Enumeration date
09/08/2015
Last updated
12/21/2021
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