Healthcare Provider Details

I. General information

NPI: 1740495829
Provider Name (Legal Business Name): FIRAS HIJAZI MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 AUGUSTA DR
LA PLACE LA
70068-1711
US

IV. Provider business mailing address

2149 AUGUSTA DR
LA PLACE LA
70068-1711
US

V. Phone/Fax

Practice location:
  • Phone: 985-651-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number026645
License Number StateLA

VIII. Authorized Official

Name: FIRAS HIJAZI
Title or Position: PRESIDENT
Credential:
Phone: 504-473-5589