Healthcare Provider Details

I. General information

NPI: 1780791236
Provider Name (Legal Business Name): MIRZA ASHHAB BEG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 VERONE TERRACE
LEESVILLE LA
71446-4649
US

IV. Provider business mailing address

935 VERONE TERRACE
LEESVILLE LA
71446
US

V. Phone/Fax

Practice location:
  • Phone: 337-392-1545
  • Fax: 337-392-1545
Mailing address:
  • Phone: 337-238-6952
  • Fax: 337-238-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13469R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: