Provider Demographics
NPI:1770724759
Name:SUGAR, JANE GULICK (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:GULICK
Last Name:SUGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:DELMAR
Other - Last Name:GULICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1501 KINGS HIGHWAY
Mailing Address - Street 2:ATTN: LEISA OGLESBY (RM. 1-201)
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-4881
Mailing Address - Fax:318-675-5069
Practice Address - Street 1:1501 KINGS HIGHWAY
Practice Address - Street 2:ATTN: LEISA OGLESBY (RM. 1-201)
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-4881
Practice Address - Fax:318-675-5069
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204909208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery