Healthcare Provider Details

I. General information

NPI: 1508845231
Provider Name (Legal Business Name): ALLAHYAR JAZAYERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY STE 302
LAFAYETTE LA
70508-6950
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-470-4653
  • Fax: 337-470-8319
Mailing address:
  • Phone: 337-470-4653
  • Fax: 257-659-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number44616
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number44616-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.12627R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: