Provider Demographics
NPI:1760591010
Name:MOUHAFFEL, ASSAD HUSEIN (MD)
Entity Type:Individual
Prefix:
First Name:ASSAD
Middle Name:HUSEIN
Last Name:MOUHAFFEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7366
Mailing Address - Country:US
Mailing Address - Phone:318-387-1946
Mailing Address - Fax:318-387-8781
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-387-1946
Practice Address - Fax:318-387-8781
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA12175R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1535877Medicaid
F92745Medicare UPIN
LA5E509CP27Medicare PIN