Provider Demographics
NPI:1124134853
Name:NAKHLAWI, YASSER M (MD)
Entity type:Individual
Prefix:DR
First Name:YASSER
Middle Name:M
Last Name:NAKHLAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-487-1477
Mailing Address - Fax:318-442-5814
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-487-1477
Practice Address - Fax:318-442-5814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL#13453R2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56790Medicaid
LA56790Medicaid