Provider Demographics
NPI:1134418437
Name:MASRI, KAMAL A (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:A
Last Name:MASRI
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 1:2551 GREENWOOD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3985
Mailing Address - Country:US
Mailing Address - Phone:318-212-8159
Mailing Address - Fax:
Practice Address - Street 1:2551 GREENWOOD RD STE 210
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3985
Practice Address - Country:US
Practice Address - Phone:210-209-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X, 390200000X
LA207549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program