Provider Demographics
NPI:1497785372
Name:JALILI, FIROOZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FIROOZ
Middle Name:
Last Name:JALILI
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:PO BOX 52545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2545
Mailing Address - Country:US
Mailing Address - Phone:337-233-2535
Mailing Address - Fax:337-235-0157
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:STE 203
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-233-2535
Practice Address - Fax:337-235-0157
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05553R208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1314340Medicaid
E78880Medicare UPIN
LA5M601Medicare PIN