Provider Demographics
NPI:1508845231
Name:JAZAYERI, ALLAHYAR (MD)
Entity Type:Individual
Prefix:
First Name:ALLAHYAR
Middle Name:
Last Name:JAZAYERI
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-4653
Mailing Address - Fax:257-659-1962
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6950
Practice Address - Country:US
Practice Address - Phone:337-470-4653
Practice Address - Fax:337-470-8319
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44616207V00000X
WI44616-20207VM0101X
LAMD.12627R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508845231Medicaid
626744OtherBOARD CERTIFICATION MATERNAL & FETAL MEDICINE