Provider Demographics
NPI:1780791236
Name:BEG, MIRZA ASHHAB (MD)
Entity type:Individual
Prefix:MR
First Name:MIRZA
Middle Name:ASHHAB
Last Name:BEG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:935 VERONE TERRACE
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446
Mailing Address - Country:US
Mailing Address - Phone:337-238-6952
Mailing Address - Fax:337-238-6956
Practice Address - Street 1:935 VERONE TERRACE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4649
Practice Address - Country:US
Practice Address - Phone:337-392-1545
Practice Address - Fax:337-392-1545
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA13469R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430498Medicaid