Fredric Thomas Siskron, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

010722 Issued in LA

Practice address

2915 Missouri Ave
Shreveport, LA 71109-4327

Phone

(318) 364-2000

NPI assigned

Oct 10, 2005

Last updated

Apr 11, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Delta Pathology Group LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Shreveport, LA
  • NPI 1548258973
  Medicare reassignment NPD
• The Delta Pathology Group, L.L.C.

  • Clinical Medical Laboratory
  • Shreveport, LA
  • NPI 1649279910
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334102400000",
    "number": "1023006590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731280",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753731280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 MISSOURI AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711094327",
            "telephone_number": "318-364-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISKRON",
        "first_name": "FREDRIC",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2012-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "010722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1920886",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moise Sinitiere, RPH
• Sino Chiropractic Health Center, LLC
• Diane L Sino, DC
• Richard Thomas Sipes, MD
• Fredric T Siskron IV, MD
• Amos L. Sit, MD
• Leesa Lee Sitter, LCSW
• Rachel Sitter, NP
• Kevin Mark Sittig, M.D.
• Sivaprakash Sivaji, DO

• Anatomic Pathology & Clinical Pathology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.