Provider Demographics
NPI:1740481506
Name:JYOTI, ANSHUMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANSHUMAN
Middle Name:
Last Name:JYOTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANSHUMAN
Other - Middle Name:
Other - Last Name:JYOTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP STE 203
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3175
Mailing Address - Country:US
Mailing Address - Phone:318-212-5871
Mailing Address - Fax:
Practice Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP STE 203
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3175
Practice Address - Country:US
Practice Address - Phone:318-212-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2041392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07925Medicaid