Basic Information
| Provider Information | |||||||||
| NPI: | 1841229978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAHRDAR, JR | ||||||||
| FirstName: | CAMBIZE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7925 YOUREE DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187986700 | ||||||||
| FaxNumber: | 3182123709 | ||||||||
| Practice Location | |||||||||
| Address1: | 7925 YOUREE DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187986700 | ||||||||
| FaxNumber: | 3182123709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 023868 | LA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1487368 | 05 | LA | MEDICAID |