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General NPI Number Information
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NPI Number | 1891953717
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY CENTER OF LOUISIANA, INC.
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 4212 W CONGRESS ST SUITE 2400E
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City | LAFAYETTE
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State | LA
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Zip | 70506-6765
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Country | US
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Telephone | 615-574-8001
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Fax | 866-566-3203
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Provider Business Mailing Address
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Address Line | 4212 W CONGRESS ST SUITE 2400E
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City | LAFAYETTE
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State | LA
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Zip | 70506-6765
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Country | US
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Telephone | 615-574-8001
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Fax | 866-566-3203
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. IRFAN ALAM
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Credential | MD
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Telephone | 615-574-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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