Provider Demographics
NPI:1669584876
Name:DOPSON, CECIL CLIFTON JR (MD)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:CLIFTON
Last Name:DOPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLIF
Other - Middle Name:
Other - Last Name:DOPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:610 HERNDON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4704
Mailing Address - Country:US
Mailing Address - Phone:318-424-3867
Mailing Address - Fax:318-424-5006
Practice Address - Street 1:610 HERNDON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4704
Practice Address - Country:US
Practice Address - Phone:318-424-3867
Practice Address - Fax:318-424-5006
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA136042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXX9X050921OtherMEDICAID
LA1309958Medicaid
LA5K297Medicare ID - Type Unspecified
LA1309958Medicaid