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General NPI Number Information
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NPI Number | 1942632633
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Entity Type | Organization
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Legal Business Name | MAGDOUCHE MEDICAL LLC
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 2739 STONE CREEK DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-8432
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Country | US
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Telephone | 318-797-1743
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Fax | 318-797-7599
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Provider Business Mailing Address
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Address Line | 2739 STONE CREEK DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-8432
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Country | US
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Telephone | 318-797-1743
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Fax | 318-797-7599
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JIHAD M EL HAYEK
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Credential | M.D.
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Telephone | 214-405-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD.204550
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License Number State | LA
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