Provider Demographics
NPI:1710072012
Name:MANSOOR, SHAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:MANSOOR
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 1:501 MEDICAL CENTER DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-484-3899
Mailing Address - Fax:318-484-3887
Practice Address - Street 1:501 MEDICAL CENTER DR STE 3A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-484-3899
Practice Address - Fax:318-484-3887
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13654 R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1435350Medicaid
LA4J401Medicare ID - Type Unspecified
LAG15322Medicare UPIN