Individual
HASSAN MOHWAD IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF PEDIATRICS, SECTION OF NEONATOLOGY, SHREVEPORT, LA 71103-4228
(318) 675-7255
(318) 675-4660
Mailing address
1501 KINGS HWY, DEPARTMENT OF PEDIATRICS, SECTION OF NEONATOLOGY, SHREVEPORT, LA 71103-4228
(318) 675-7255
(318) 675-4660
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
11168R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1688923
—
LA
Enumeration date
07/20/2006
Last updated
11/16/2007
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