Healthcare Provider Details

I. General information

NPI: 1952716979
Provider Name (Legal Business Name): ASIF TALUKDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 507
BATON ROUGE LA
70808-4366
US

IV. Provider business mailing address

1459 LANEY WALKER BLVD AE3042
AUGUSTA GA
30912-0002
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-1156
  • Fax: 225-767-5980
Mailing address:
  • Phone: 702-721-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number7260
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number326682
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number326682
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: