Basic Information
| Provider Information | |||||||||
| NPI: | 1467408492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AZMEH | ||||||||
| FirstName: | WAREF | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4890 BLUEBONNET BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708099644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527693922 | ||||||||
| FaxNumber: | 2257693933 | ||||||||
| Practice Location | |||||||||
| Address1: | 4890 BLUEBONNET BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708099644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257693922 | ||||||||
| FaxNumber: | 2257693933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L-12821R | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | MD12821R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | BA5009522 | 01 | DEA | OTHER | 1548260 | 05 | IA | MEDICAID |