Provider Demographics
NPI:1306875570
Name:SAMPER, EDWARD RONALD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RONALD
Last Name:SAMPER
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 1:1666 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5714
Mailing Address - Country:US
Mailing Address - Phone:318-212-3520
Mailing Address - Fax:318-212-3525
Practice Address - Street 1:1666 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5714
Practice Address - Country:US
Practice Address - Phone:318-212-3520
Practice Address - Fax:318-212-3525
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05522R208000000X, 208600000X
LA0522R208C00000X
LAMD.05522R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351741Medicaid
LA1351741Medicaid
LA5H316C731Medicare Oscar/Certification
D16953Medicare UPIN
LA5H316Medicare PIN