Provider Demographics
NPI:1508824970
Name:DOLLAR, MARK FREEMAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FREEMAN
Last Name:DOLLAR
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 1:122 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5332
Mailing Address - Country:US
Mailing Address - Phone:318-322-0058
Mailing Address - Fax:318-362-0081
Practice Address - Street 1:122 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5332
Practice Address - Country:US
Practice Address - Phone:318-322-0058
Practice Address - Fax:318-362-0081
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1672912Medicaid
G14542Medicare UPIN
LA5W441Medicare PIN