Provider Demographics
NPI:1770565319
Name:MUFTAH, LOAY A (MD, DABR)
Entity type:Individual
Prefix:DR
First Name:LOAY
Middle Name:A
Last Name:MUFTAH
Suffix:
Gender:M
Credentials:MD, DABR
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 COLONY PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6346
Mailing Address - Country:US
Mailing Address - Phone:949-245-9995
Mailing Address - Fax:949-706-2627
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-757-0552
Practice Address - Fax:225-763-9997
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT550672085R0202X
PAMD4574342085R0202X
CAA866832085R0202X
TN456292085R0202X
LA3209732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30506Medicare UPIN