Provider Demographics
NPI:1083929954
Name:HENOCK G ZABHER LLC
Entity Type:Organization
Organization Name:HENOCK G ZABHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HENOCK
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEBREGZIABHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-820-8266
Mailing Address - Street 1:8007 AMY HEWES DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-4605
Mailing Address - Country:US
Mailing Address - Phone:318-820-8266
Mailing Address - Fax:
Practice Address - Street 1:8007 AMY HEWES DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-4605
Practice Address - Country:US
Practice Address - Phone:318-820-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA030954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578223Medicaid