Provider Demographics
NPI:1912055468
Name:HOSSEIN KHAZEI TABARI LTD
Entity Type:Organization
Organization Name:HOSSEIN KHAZEI TABARI LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TABARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-735-7810
Mailing Address - Street 1:1616 S COLUMBIA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-5880
Mailing Address - Country:US
Mailing Address - Phone:985-735-7810
Mailing Address - Fax:985-732-0495
Practice Address - Street 1:1616 S COLUMBIA ST
Practice Address - Street 2:SUITE E
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-5880
Practice Address - Country:US
Practice Address - Phone:985-735-7810
Practice Address - Fax:985-732-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06731R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06731ROtherLA STATE LICENSE
LA1350443Medicaid
LA06731ROtherLA STATE LICENSE
LA1350443Medicaid