Healthcare Provider Details

I. General information

NPI: 1619396702
Provider Name (Legal Business Name): AYA AL ASFARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY INTENAL MEDICINE
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-0050
  • Fax:
Mailing address:
  • Phone: 318-813-2528
  • Fax: 318-813-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number320541
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: