Provider Demographics
NPI:1891013629
Name:AHMED, NAFISA (MD)
Entity Type:Individual
Prefix:
First Name:NAFISA
Middle Name:
Last Name:AHMED
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 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-6076
Mailing Address - Fax:318-675-6059
Practice Address - Street 1:7430 BARLITE BLVD STE 104
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1366
Practice Address - Country:US
Practice Address - Phone:210-977-9080
Practice Address - Fax:210-977-8480
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAPGY201177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program