Provider Demographics
NPI:1609023944
Name:SANA, MUDDASSIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUDDASSIR
Middle Name:
Last Name:SANA
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:225-743-2345
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 220
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5020
Practice Address - Country:US
Practice Address - Phone:225-743-2345
Practice Address - Fax:225-743-2543
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205323207L00000X
TXP5886207L00000X
LA205323208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology