OB GYN Associates of Shreveport

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

OB GYN ASSOCIATES OF SHREVEPORT

Practice address

7941 Youree Dr
Shreveport, LA 71105-5538

Phone

(318) 797-7941

Fax

(318) 797-7991

NPI assigned

May 18, 2007

Reactivated

Feb 4, 2019

Organization subpart

No

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

Authorized official

Name

Dr. John Walter Waterfallen, M.D.

Title

President

Phone

(318) 797-7941

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1104034867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7941 YOUREE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055538",
            "telephone_number": "318-797-7941",
            "fax_number": "318-797-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7941 YOUREE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055538",
            "telephone_number": "318-797-7941",
            "fax_number": "318-797-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OB GYN ASSOCIATES OF SHREVEPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2019-02-04",
        "deactivation_date": "2017-10-04",
        "reactivation_date": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "WATERFALLEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-797-7941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Obstetrics & Gynecology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.