Basic Information
| Provider Information | |||||||||
| NPI: | 1689789083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELIM | ||||||||
| FirstName: | NIAZY | ||||||||
| MiddleName: | MAHMOUD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD, MBCHB, FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 W PRIEN LAKE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375028706 | ||||||||
| FaxNumber: | 3372101271 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 W PRIEN LAKE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375028706 | ||||||||
| FaxNumber: | 3372101271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31350 | KS | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | E-3815 | AR | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2002002474 | MO | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.