Basic Information
Provider Information
NPI: 1003801044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AFZAL
FirstName: FIAZ
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 VETERANS BLVD
Address2:  
City: KENNER
State: LA
PostalCode: 70062
CountryCode: US
TelephoneNumber: 5048919800
FaxNumber: 5048919712
Practice Location
Address1: 1000 VETERANS BLVD
Address2:  
City: KENNER
State: LA
PostalCode: 70062
CountryCode: US
TelephoneNumber: 5048919800
FaxNumber: 5048919712
Other Information
ProviderEnumerationDate: 09/15/2005
LastUpdateDate: 06/09/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X11980RLAY Allopathic & Osteopathic PhysiciansInternal Medicine 
208D00000X11980RLAN Allopathic & Osteopathic PhysiciansGeneral Practice 

ID Information
IDTypeStateIssuerDescription
168755305LA MEDICAID


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