Provider Demographics
NPI:1841229978
Name:SHAHRDAR, CAMBIZE (MD)
Entity Type:Individual
Prefix:
First Name:CAMBIZE
Middle Name:
Last Name:SHAHRDAR
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 1:7925 YOUREE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5127
Mailing Address - Country:US
Mailing Address - Phone:318-798-6700
Mailing Address - Fax:318-212-3709
Practice Address - Street 1:7925 YOUREE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5127
Practice Address - Country:US
Practice Address - Phone:318-798-6700
Practice Address - Fax:318-212-3709
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023868207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487368Medicaid
LA1487368Medicaid
H09335Medicare UPIN
LA4J634Medicare PIN
LA5H049Medicare PIN
LA5H049CJ88Medicare PIN