Provider Demographics
NPI:1619032141
Name:TABARI, HOSSEIN K (MD)
Entity Type:Individual
Prefix:MR
First Name:HOSSEIN
Middle Name:K
Last Name:TABARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 S COLUMBIA ST
Mailing Address - Street 2:STE E
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-5880
Mailing Address - Country:US
Mailing Address - Phone:985-735-7810
Mailing Address - Fax:985-732-0495
Practice Address - Street 1:1616 S. COLUMBIA ST.
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427
Practice Address - Country:US
Practice Address - Phone:985-735-7810
Practice Address - Fax:985-732-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06731R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350443Medicaid
5CM77Medicare PIN
LA1350443Medicaid
B89306Medicare UPIN
LABT0196560OtherDEA