Healthcare Provider Details

I. General information

NPI: 1255361069
Provider Name (Legal Business Name): MOHAMMAD SHBEEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 MASONIC DR
ALEXANDRIA LA
71301-3842
US

IV. Provider business mailing address

3349 MASONIC DR
ALEXANDRIA LA
71301-3842
US

V. Phone/Fax

Practice location:
  • Phone: 318-767-8393
  • Fax:
Mailing address:
  • Phone: 318-767-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number1171R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: