Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4832 | LA |
NPI | 1104047976 |
---|---|
Provider Name | Dr. Hisham F Nasr |
First Address | Metairie, LA 70005 |
Second Address | Metairie, LA 70005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |