Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD.04535R | LA |
NPI | 1063411361 |
---|---|
Provider Name | Dr. Mahmoud Daftary |
First Address | New Orleans, LA 70121 |
Second Address | Slidell, LA 70461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00122909 | (05) | MS |
1329444 | (05) | LA |
B63096 | (02) | LA |
P00396221 | RAILROAD MEDICARE (01) | LA |