Provider Demographics
NPI:1255399622
Name:ALAM, MOHAMMAD JAHIRUL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:JAHIRUL
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:832 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4802
Mailing Address - Country:US
Mailing Address - Phone:318-868-6600
Mailing Address - Fax:318-868-3451
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-4881
Practice Address - Fax:318-675-5069
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.08670R207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1933872Medicaid
LAE41215Medicare UPIN
LA5A221DF59Medicare PIN
LA5R263F600Medicare PIN