Provider Demographics
NPI:1407858087
Name:FIRST CARE PHYSICIAN
Entity Type:Organization
Organization Name:FIRST CARE PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARAKSHAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-381-2727
Mailing Address - Street 1:PO BOX 261166
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70826-1166
Mailing Address - Country:US
Mailing Address - Phone:337-289-8970
Mailing Address - Fax:337-289-8971
Practice Address - Street 1:3401 NORTH BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3743
Practice Address - Country:US
Practice Address - Phone:225-381-2727
Practice Address - Fax:225-381-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11841R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681971Medicaid
LA1681971Medicaid
G27376Medicare UPIN