Provider Demographics
NPI:1689789083
Name:SELIM, NIAZY MAHMOUD (MD, PHD, MBCHB, FACS)
Entity Type:Individual
Prefix:DR
First Name:NIAZY
Middle Name:MAHMOUD
Last Name:SELIM
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Gender:M
Credentials:MD, PHD, MBCHB, FACS
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Mailing Address - Street 1:215 W PRIEN LAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8450
Mailing Address - Country:US
Mailing Address - Phone:337-502-8706
Mailing Address - Fax:337-210-1271
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8450
Practice Address - Country:US
Practice Address - Phone:337-502-8706
Practice Address - Fax:337-210-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS31350208600000X
ARE-3815208600000X
MO2002002474208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery