Provider Demographics
NPI:1861888760
Name:ALEXANDER, AJIT (MD)
Entity type:Individual
Prefix:
First Name:AJIT
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19284
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71149-0284
Mailing Address - Country:US
Mailing Address - Phone:318-773-0657
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 19284
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71149-0284
Practice Address - Country:US
Practice Address - Phone:318-773-0657
Practice Address - Fax:318-688-1559
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320814207P00000X, 207Q00000X, 390200000X, 207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program