Active NPI
Reem Mansour, M.D.
- Anesthesiology Physician
- Monroe, LA
National Provider Identifier
1679583934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 13308R
- Practice address
- 4864 Jackson Street
Monroe, LA 71202-6400 - Phone
- (318) 330-7626
- Fax
- (318) 330-7648
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 13308R | LA | Primary |
Addresses
Primary practice location
4864 Jackson Street
Monroe, LA 71202-6400
Mailing address
4864 Jackson Street
Monroe, LA 71202-6400
Phone (318) 330-7626
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1567540 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13308R | LA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412640000000",
"number": "1679583934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4864 JACKSON STREET",
"city": "MONROE",
"state": "LA",
"postal_code": "712026400",
"telephone_number": "318-330-7626",
"fax_number": "318-330-7648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4864 JACKSON STREET",
"city": "MONROE",
"state": "LA",
"postal_code": "712026400",
"telephone_number": "318-330-7626",
"fax_number": "318-330-7648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOUR",
"first_name": "REEM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2014-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "LA",
"license": "13308R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1567540",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.