Provider Demographics
NPI:1982713657
Name:SINGH, KRISHNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:R
Last Name:SINGH
Suffix:
Gender:M
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:PO BOX 17798
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71138-0798
Mailing Address - Country:US
Mailing Address - Phone:318-686-5255
Mailing Address - Fax:318-686-5239
Practice Address - Street 1:6821 PINES RD STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2547
Practice Address - Country:US
Practice Address - Phone:318-686-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA09508R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1952168Medicaid
LAE95244Medicare UPIN
LA1952168Medicaid