Provider Demographics
NPI:1336169275
Name:EGGERSTEDT, JANE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:EGGERSTEDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF SURGERY, CARDIOVASCULAR
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-813-2655
Mailing Address - Fax:318-813-2673
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF SURGERY, CARDIOVASCULAR
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2655
Practice Address - Fax:318-813-2673
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07090R208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359998Medicaid
LAA76289Medicare UPIN
LA1359998Medicaid