Healthcare Provider Details

I. General information

NPI: 1770332769
Provider Name (Legal Business Name): AHMAD KABIR MUGHAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 03/20/2025
Certification Date:
Deactivation Date: 01/10/2025
Reactivation Date: 03/20/2025

III. Provider practice location address

309 JACKSON STREET. P.O BOX 1901
MONROE LA
71210
US

IV. Provider business mailing address

309 JACKSON STREET. P.O BOX 1901
MONROE LA
71210
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4000
  • Fax: 318-966-4142
Mailing address:
  • Phone: 318-966-4000
  • Fax: 318-966-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: