Provider Demographics
NPI:1821027202
Name:FOSS, JEFFREY FRANK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FRANK
Last Name:FOSS
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 1:2514 BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3146
Mailing Address - Country:US
Mailing Address - Phone:318-212-5966
Mailing Address - Fax:318-212-5963
Practice Address - Street 1:2514 BERT KOUNS LOOP
Practice Address - Street 2:SUITE 6
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3146
Practice Address - Country:US
Practice Address - Phone:318-212-5966
Practice Address - Fax:318-212-5963
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018473207R00000X
LAMD.018473207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932787Medicaid
LA5R110Medicare PIN
LAB30731Medicare UPIN
LA1932787Medicaid