Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 20118 | LA |
N | 204F00000X | Transplant Surgeon | 24176 | TN |
NPI | 1831155688 |
---|---|
Provider Name | Dr. Hosein M Shokouh-Amiri |
First Address | Shreveport, LA 71106-7776 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123102001 | (05) | AR |
167279 | BC/BS TN (01) | |
3073281 | (05) | TN |
F58008 | (02) |