Provider Demographics
NPI:1609867415
Name:ESKANDER, MAGDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:
Last Name:ESKANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGDY
Other - Middle Name:
Other - Last Name:SHEHATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9627 GARDERE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-4603
Mailing Address - Country:US
Mailing Address - Phone:318-797-3635
Mailing Address - Fax:318-797-3635
Practice Address - Street 1:2724 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-4635
Practice Address - Country:US
Practice Address - Phone:318-212-4750
Practice Address - Fax:318-212-8435
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200836207P00000X, 207Q00000X
ARE-4255207P00000X, 207Q00000X
LAMD 2008362083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578801Medicaid
AR156469001Medicaid
AR5N113OtherBCBS
I26209Medicare UPIN
AR5N113OtherBCBS
AR5N113Medicare ID - Type Unspecified