Provider Demographics
NPI:1366903569
Name:CHESTER, STEPHEN JACK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JACK
Last Name:CHESTER
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 1:3853 MARYLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1019
Mailing Address - Country:US
Mailing Address - Phone:504-975-3499
Mailing Address - Fax:
Practice Address - Street 1:2890 DOUGLAS DR.
Practice Address - Street 2:SUITE #100
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-742-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA341324208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice