Provider Demographics
NPI:1518349919
Name:KFOURY, BADER (MD)
Entity Type:Individual
Prefix:DR
First Name:BADER
Middle Name:
Last Name:KFOURY
Suffix:
Gender:F
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:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:STE 408
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6950
Practice Address - Country:US
Practice Address - Phone:337-470-3980
Practice Address - Fax:337-470-3989
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2021-03-31
Deactivation Date:2016-02-02
Deactivation Code:
Reactivation Date:2016-03-07
Provider Licenses
StateLicense IDTaxonomies
LAPENDING207RN0300X
NY244202390200000X
NY390200000X
PAMT216942390200000X
LA324281207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program