Provider Demographics
NPI:1124010939
Name:ZAFFATER, NORMAN A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:A
Last Name:ZAFFATER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR STE 460
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1918
Mailing Address - Country:US
Mailing Address - Phone:318-747-5838
Mailing Address - Fax:318-747-5827
Practice Address - Street 1:2449 HOSPITAL DR STE 460
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1918
Practice Address - Country:US
Practice Address - Phone:318-747-5838
Practice Address - Fax:318-747-5827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10876R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1496057Medicaid
LA1124010939Medicare NSC
5Y490Medicare PIN
LA1496057Medicaid