Provider Demographics
NPI:1942268479
Name:NASSAR, MAURICE GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:GABRIEL
Last Name:NASSAR
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-767-7388
Mailing Address - Fax:225-767-7389
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 508
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-767-7388
Practice Address - Fax:225-767-7389
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA012357OtherSTATE LICENSE
LA04-00187OtherUNITED HEALTH
LA1176893Medicaid
54296Medicare ID - Type Unspecified
LA04-00187OtherUNITED HEALTH