Provider Demographics
NPI:1467721696
Name:ASSIRI, SALEM ALI (MBBS)
Entity Type:Individual
Prefix:
First Name:SALEM
Middle Name:ALI
Last Name:ASSIRI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1327
Mailing Address - Country:US
Mailing Address - Phone:504-842-3260
Mailing Address - Fax:504-842-3193
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:BH 634
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3260
Practice Address - Fax:504-842-3193
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAINTERNOtherINTERN