MEDICARE: DR. RIAZ MASUD CHAUDHRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	3939R	LA
2	207Q00000X	Family Medicine Physician	3939R	LA

General Provider Information

NPI Number	:	1306882568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIAZ MASUD CHAUDHRY MD

Provider Business Mailing Address
First Line	:	PO DRAWER 1470
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342
Country	:	US
Telephone Number	:	318-992-4133
Fax Number	:	318-992-4134

Provider Business Practice Location Address
First Line	:	11809 HWY 84 W
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342
Country	:	US
Telephone Number	:	318-992-4133
Fax Number	:	318-992-4134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	09/28/2020

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