Basic Information
| Provider Information | |||||||||
| NPI: | 1407858087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST CARE PHYSICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 261166 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708261166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898970 | ||||||||
| FaxNumber: | 3372898971 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 NORTH BLVD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812727 | ||||||||
| FaxNumber: | 2253812753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WAHID | ||||||||
| AuthorizedOfficialFirstName: | DARAKSHAN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2253812727 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11841R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1681971 | 05 | LA | MEDICAID |