Basic Information
| Provider Information | |||||||||
| NPI: | 1861717662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CEFALU | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 GASTON AVE | ||||||||
| Address2: | STE 1205 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146928262 | ||||||||
| FaxNumber: | 2148539415 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 BERT KOUNS | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711068150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186830411 | ||||||||
| FaxNumber: | 3186035461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD.207489 | LA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | R8872 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.