Healthcare Provider Details

I. General information

NPI: 1427041771
Provider Name (Legal Business Name): SYED FAZAL-UR-REHMAN M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date: 03/27/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY BLDG. N - STE. 1400
LAFAYETTE LA
70508
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-9003
  • Fax: 337-988-9921
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12136R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: