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General NPI Number Information
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NPI Number | 1073774030
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA RHEUMATOLOGY, LLC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 3311 PRESCOTT RD STE 211
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3983
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Country | US
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Telephone | 318-767-8393
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Fax | 318-767-8399
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Provider Business Mailing Address
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Address Line | 3311 PRESCOTT RD STE 211
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3983
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Country | US
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Telephone | 318-767-8393
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Fax | 318-767-8399
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MOHAMMAD IZZAT SHBEEB
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Credential | M.D.
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Telephone | 318-767-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 11711R
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License Number State | LA
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