Provider Demographics
NPI:1679595607
Name:KHOURI, ANAS YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:YOUSSEF
Last Name:KHOURI
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:9605 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2550
Practice Address - Country:US
Practice Address - Phone:504-738-1604
Practice Address - Fax:504-738-7860
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11330R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1683574Medicaid
MS06559390Medicaid
G32392Medicare UPIN
LA1683574Medicaid
LA542996YH3UMedicare PIN
LA5W978F669Medicare PIN