Provider Demographics
NPI:1700935640
Name:ZEIBO, MOHAMMAD AWNI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AWNI
Last Name:ZEIBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:BOX 30125
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-484-3535
Mailing Address - Fax:318-484-3536
Practice Address - Street 1:301 4TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-484-3535
Practice Address - Fax:318-484-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2015052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1093181Medicaid
LA1093181Medicaid