643 Extenders LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

643 EXTENDERS LLC

Practice address

1500 Line Ave Ste 204
Shreveport, LA 71101-4648

Phone

(318) 629-5496

NPI assigned

Aug 20, 2026

Organization subpart

No

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

Authorized official

Name

Dr. John David Googe, MD

Title

President

Phone

(318) 629-5496

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1787184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787184000000",
    "number": "1821904863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 CROCKETT ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013605",
            "telephone_number": "318-629-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LINE AVE STE 204",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014648",
            "telephone_number": "318-629-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "643 EXTENDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-20",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "GOOGE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-629-5496",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.