Healthcare Provider Details

I. General information

NPI: 1790774081
Provider Name (Legal Business Name): TAWFIK M. MUKHTAR-BENGHOZI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TAWFIK BENGHOZI M.D.

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 COLISEUM BLVD.
ALEXANDRIA LA
71303-3714
US

IV. Provider business mailing address

6213 TENNYSON OAKS LN
ALEXANDRIA LA
71301-2759
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9339
  • Fax: 318-443-9116
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number08698R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: