Healthcare Provider Details

I. General information

NPI: 1306882568
Provider Name (Legal Business Name): RIAZ MASUD CHAUDHRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11809 HWY 84 W
JENA LA
71342
US

IV. Provider business mailing address

PO DRAWER 1470
JENA LA
71342
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-4133
  • Fax: 318-992-4134
Mailing address:
  • Phone: 318-992-4133
  • Fax: 318-992-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3939R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3939R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: