Provider Demographics
NPI:1154348050
Name:JEROUDI, MAJED ALDIN (MD)
Entity type:Individual
Prefix:
First Name:MAJED
Middle Name:ALDIN
Last Name:JEROUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 ELIZABETH AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2123
Mailing Address - Country:US
Mailing Address - Phone:318-698-0035
Mailing Address - Fax:318-813-1020
Practice Address - Street 1:2032 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2123
Practice Address - Country:US
Practice Address - Phone:318-698-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11427R2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669580Medicaid
LA5W409F600Medicare ID - Type Unspecified
LA1669580Medicaid