Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | L#13453R | LA |
NPI | 1124134853 |
---|---|
Provider Name | Dr. Yasser M Nakhlawi |
First Address | Alexandria, LA 71301-3900 |
Second Address | Alexandria, LA 71301-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 12/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56790 | (05) | LA |
G45593 | (02) | LA |