Provider Demographics
NPI:1750362109
Name:KISTLER, ERNEST L (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:L
Last Name:KISTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9600
Mailing Address - Street 2:DEPT 09-039
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-9600
Mailing Address - Country:US
Mailing Address - Phone:866-214-8600
Mailing Address - Fax:888-411-4191
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:866-214-8600
Practice Address - Fax:888-411-4191
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014584207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1344877Medicaid
LA050016353OtherMEDICARE RAILROAD
B61275Medicare UPIN
LA5L351CF39Medicare UPIN