Provider Demographics
NPI:1659804979
Name:CEFALU, JOHN N (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:CEFALU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5682
Mailing Address - Country:US
Mailing Address - Phone:318-797-5848
Mailing Address - Fax:318-797-5844
Practice Address - Street 1:8731 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5682
Practice Address - Country:US
Practice Address - Phone:318-797-5848
Practice Address - Fax:318-797-5844
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338490207L00000X, 207LP2900X, 208VP0014X
FLME157022208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine