Healthcare Provider Details

I. General information

NPI: 1902823966
Provider Name (Legal Business Name): SAMI LABIB BAHNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF PEDIATRIC, SECTION OF ALLERGY & IMMUNOLOG
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF PEDIATRIC, SECTION OF ALLERGY & IMMUNOLOG
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-8601
  • Fax: 318-675-8872
Mailing address:
  • Phone: 318-675-8601
  • Fax: 318-675-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number04267R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: