Individual
DR. BRIAN L DOCKENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4600
(318) 798-4412
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4600
(318) 798-4412
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
09794R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020025718
RAILROAD MEDICARE NUMBER
LA
01
—
1053315846
GROUP MEDICARE NUMBER
LA
01
—
135485409
TEXAS MEDICAID NUMBER
TX
05
—
1966053
—
LA
Enumeration date
06/09/2005
Last updated
12/11/2020
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