Individual
JEREMY CLAIBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
510 E. STONER AVENUE, OVERTON BROOKS VA MEDICAL CENTER, SHREVEPORT, LA 71101
(318) 990-5000
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(870) 779-2750
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
204692
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01733393
MS MEDICAID
MS
05
—
1053732
—
LA
01
—
4R117
MEDICARE PTAN
LA
01
—
P01158547
RAILROAD MEDICARE
LA
Enumeration date
05/14/2008
Last updated
03/11/2024
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