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Organization
ISLAM LLC
Active
Organization
ISLAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAHRUL ISLAM MD (PHYSICIAN)
(318) 773-0657
Entity
Organization
Contact information
Practice address
9815 PARAGON LN, SHREVEPORT, LA 71115
(318) 773-0657
Mailing address
PO BOX 19284, SHREVEPORT, LA 71149-0284
(318) 773-0657
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206516
MEDICAL LICENSE
LA
Enumeration date
11/30/2017
Last updated
06/19/2018
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