Jeffrey T Overdyke, MD

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

203179 Issued in LA

Practice address

2508 Bert Kouns Loop
Suite 303
Shreveport, LA 71118-3133

Phone

(318) 212-5850

Fax

(318) 212-5855

NPI assigned

May 10, 2007

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• WK Psychology Specialty Center

  • Clinical Psychologist
  • Shreveport, LA
  • NPI 1144543489
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1942414552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-8574",
            "fax_number": "318-212-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 303",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5850",
            "fax_number": "318-212-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERDYKE",
        "first_name": "JEFFREY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "LA",
            "license": "203179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "4M560DL73",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1810975",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bismarck Gitenyi Osumo, M.D.
• Lydia Barham Oswalt
• D'Juna A Otis
• Charles Godfried Otu-Nyarko, M.D
• Laura Ourso
• William L Overdyke, MD
• Overton Brooks VA
• Overton Brooks VA Hospital
• Overton Brooks VA Medical Center
• Overton Brooks VA Medical Center

• Geriatric Psychiatry Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Geriatric Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.