Provider Demographics
NPI:1215999057
Name:NACHABE, MOUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:MOUSTAFA
Middle Name:
Last Name:NACHABE
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 1:843 MILLING AVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4442
Mailing Address - Country:US
Mailing Address - Phone:985-785-5852
Mailing Address - Fax:985-785-5811
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-785-5852
Practice Address - Fax:985-785-5811
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD10655R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1452904Medicaid
LA1925349Medicaid
LA1444642Medicaid
LA1990078Medicaid
LA1579483Medicaid
LA1925349Medicaid