Healthcare Provider Details

I. General information

NPI: 1023009784
Provider Name (Legal Business Name): JAMAL GHAZI SAQER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 ASTER ST
LAKE CHARLES LA
70601-8824
US

IV. Provider business mailing address

PO BOX 122539 DEPT 2539
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-8900
  • Fax: 337-480-8901
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number12000R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: