Healthcare Provider Details

I. General information

NPI: 1316855570
Provider Name (Legal Business Name): MOHAMED EZZAT MOHAMED ARAFA MAHMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

3131 KNIGHT ST APT 182
SHREVEPORT LA
71105-2582
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-7869
  • Fax: 318-675-5069
Mailing address:
  • Phone: 945-341-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number354023
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: