Healthcare Provider Details

I. General information

NPI: 1114923901
Provider Name (Legal Business Name): GHAYAS AHMED QURESHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GHAYAS AHMED M.D.

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 CROWLEY RAYNE HWY
CROWLEY LA
70526
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-3222
  • Fax: 337-788-6413
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11742R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11742R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: