Healthcare Provider Details

I. General information

NPI: 1639681927
Provider Name (Legal Business Name): MANSOUR ALGHAMDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

1542 TULANE AVE # T4M2
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-702-3000
  • Fax:
Mailing address:
  • Phone: 504-568-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number332559
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: