Provider Demographics
NPI:1477543239
Name:YAZDI, MASOUD (MD)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:YAZDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SAINT LANDRY ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3549
Mailing Address - Country:US
Mailing Address - Phone:337-233-3538
Mailing Address - Fax:337-233-3539
Practice Address - Street 1:224 SAINT LANDRY ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3549
Practice Address - Country:US
Practice Address - Phone:337-233-3538
Practice Address - Fax:337-233-3539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.07429R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1906565Medicaid
LA52288Medicare ID - Type Unspecified
LA1906565Medicaid