Provider Demographics
NPI:1972792851
Name:M. CRAIG BOZEMAN, M.D., A.P.M.C.
Entity Type:Organization
Organization Name:M. CRAIG BOZEMAN, M.D., A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-798-3823
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:STE 820
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-798-3823
Mailing Address - Fax:318-798-3887
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:STE 820
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-798-3823
Practice Address - Fax:318-798-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978981Medicaid
LA5CA53Medicare PIN
LAF73129Medicare UPIN