Provider Demographics
NPI:1275565905
Name:POWERS, CHARLES ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALFRED
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-212-7910
Mailing Address - Fax:318-212-7915
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 420
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-212-7910
Practice Address - Fax:318-212-7915
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03465R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11436000Medicaid
LA5K960Medicare PIN
LA5K960DB42Medicare PIN
LA11436000Medicaid