Provider Demographics
NPI:1407042435
Name:SUH, HESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:HESTER
Middle Name:
Last Name:SUH
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 1:2709 MACKEY LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2556
Mailing Address - Country:US
Mailing Address - Phone:318-505-7626
Mailing Address - Fax:877-571-9488
Practice Address - Street 1:2709 MACKEY LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2556
Practice Address - Country:US
Practice Address - Phone:318-505-7626
Practice Address - Fax:877-571-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063660A208000000X
LAMD.204975208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200891400Medicaid
LA2175581Medicaid
IN231360Medicare PIN
LA2175581Medicaid