Provider Demographics
NPI:1972503415
Name:KATZ, STEPHEN PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PHILIP
Last Name:KATZ
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 1:3311 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3985
Mailing Address - Country:US
Mailing Address - Phone:318-443-9300
Mailing Address - Fax:318-443-6512
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 415
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-443-9300
Practice Address - Fax:318-443-6512
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-19
Provider Licenses
StateLicense IDTaxonomies
LA020871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1908606Medicaid
LA5N445Medicare ID - Type Unspecified
LA1908606Medicaid