=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528053824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABDEL FARID ABU SHAMAT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2005
-----------------------------------------------------
Last Update Date | 11/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 DR MICHAEL DEBAKEY DR SUITE 140
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-5887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-494-7090
-----------------------------------------------------
Fax | 337-494-7040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 DR MICHAEL DEBAKEY DR SUITE 140
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-5887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-494-7090
-----------------------------------------------------
Fax | 337-494-7040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 11617R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 11617R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------