Provider Demographics
NPI:1053818583
Name:DEADMOND, AMANDA (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DEADMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 ELLERBE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7403
Mailing Address - Country:US
Mailing Address - Phone:318-408-0100
Mailing Address - Fax:601-202-4685
Practice Address - Street 1:9391 ELLERBE RD STE C
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7403
Practice Address - Country:US
Practice Address - Phone:318-408-0100
Practice Address - Fax:601-202-4685
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA329257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology