Provider Demographics
NPI:1396795795
Name:NEGRON, GERARDO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:NEGRON
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 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 750
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3939
Mailing Address - Fax:318-212-3965
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 750
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3939
Practice Address - Fax:318-212-3965
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14761R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1130923Medicaid
LA1130923Medicaid
LA4E612DB61Medicare PIN
LA4E612DH74Medicare PIN
LA4E612Medicare PIN