Provider Demographics
NPI:1790705010
Name:PREJEAN, CURTIS A JR (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:A
Last Name:PREJEAN
Suffix:JR
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 1:2751 ALBERT L. BICKNELL DR.
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3920
Mailing Address - Country:US
Mailing Address - Phone:318-227-9777
Mailing Address - Fax:318-459-1188
Practice Address - Street 1:2751 ALBERT L. BICKNELL DR.
Practice Address - Street 2:SUITE 5C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3920
Practice Address - Country:US
Practice Address - Phone:318-227-9777
Practice Address - Fax:318-459-1188
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44098208G00000X
LA015075208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440980Medicaid
CA00A440980F94OtherCAL OPTIMA NUMBER
CA330005226OtherMEDICARE RAILROAD PIN
CA00A440980OtherBLUE SHIELD PIN
CAE58688Medicare UPIN
CA00A440980OtherBLUE SHIELD PIN