Provider Demographics
NPI:1427097930
Name:SOUD, JOHN CALEIST (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CALEIST
Last Name:SOUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 MANSFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3137
Mailing Address - Country:US
Mailing Address - Phone:318-629-3763
Mailing Address - Fax:318-629-3767
Practice Address - Street 1:9300 MANSFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3137
Practice Address - Country:US
Practice Address - Phone:318-629-3763
Practice Address - Fax:318-629-3767
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8420207P00000X
LADO000012207P00000X
ARE-7954207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1239488Medicaid
H04302Medicare UPIN
LA1239488Medicaid