Healthcare Provider Details

I. General information

NPI: 1992704142
Provider Name (Legal Business Name): NASHAT M KHANFAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 KILPATRICK BLVD
MONROE LA
71201
US

IV. Provider business mailing address

130 DESIARD ST STE 355
MONROE LA
71201-7319
US

V. Phone/Fax

Practice location:
  • Phone: 318-410-9898
  • Fax: 318-807-9002
Mailing address:
  • Phone: 318-807-7875
  • Fax: 318-812-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13306R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: