Provider Demographics
NPI:1659456242
Name:HOJAILI, BERNARD S (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:S
Last Name:HOJAILI
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 11937
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-1937
Mailing Address - Country:US
Mailing Address - Phone:337-560-1711
Mailing Address - Fax:337-359-9102
Practice Address - Street 1:2312 E MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4064
Practice Address - Country:US
Practice Address - Phone:337-560-1711
Practice Address - Fax:337-359-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200973207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00432990OtherRAILROAD MEDICARE
LA1581861Medicaid
LA1581861Medicaid
LAP00432990OtherRAILROAD MEDICARE