Healthcare Provider Details

I. General information

NPI: 1750345559
Provider Name (Legal Business Name): SAMIR A SALAMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KALISTE SALOOM RD
LAFAYETTE LA
70508-4210
US

IV. Provider business mailing address

800 KALISTE SALOOM RD
LAFAYETTE LA
70508-4210
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-2400
  • Fax: 337-232-3656
Mailing address:
  • Phone: 337-233-2400
  • Fax: 337-232-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number08423R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: