Provider Demographics
NPI:1508863556
Name:REMBERT, PAULA E (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:E
Last Name:REMBERT
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 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1453 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE 221
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6800
Practice Address - Country:US
Practice Address - Phone:318-795-4766
Practice Address - Fax:318-795-4763
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD018978207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1903698Medicaid
LA5N193BC11Medicare PIN
LA1903698Medicaid
5N193BC11OtherMEDICARE
LA1903698Medicaid