Individual provider Active NPI

Taher Mamdouh T Tayeb, MBBS

  • Cardiovascular Disease Physician
  • Shreveport, LA
National Provider Identifier
1992238695
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
337755 Issued in LA
Practice address
1541 Kings Hwy
Shreveport, LA 71103-4228
Phone
(318) 626-0000
Fax
(318) 629-4833
NPI assigned
Apr 10, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 337755 LA
Nuclear Cardiology Physician 207UN0901X 337755 LA
Cardiovascular Disease Physician 207RC0000X 337755 LA Primary

Addresses

Primary practice location

1541 Kings Hwy
Shreveport, LA 71103-4228

Mailing address

1512 W Kirby PL
Shreveport, LA 71103-3822

Other practice location 1

2150 Pennsylvania Avenue, NW
The GW Medical Faculty Associates
Washinton, DC 20037
Phone (202) 741-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803004239 LA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0143593582 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desoto Regional Family MedicineGroup PAC ID 7719970599, 8 clinicians
Desoto Hospital AssociationGroup PAC ID 2163321829, 35 clinicians

Practice addresses (Care Compare)

130 Jefferson St
Mansfield, LA 71052-2602
Phone (318) 872-2700

1541 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 675-5000

207 Jefferson St
Mansfield, LA 71052-2603
Phone (318) 871-3109

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Desoto Hospital Association Current Accepting new patients
Desoto Hospital Association CurrentSince Aug 8, 2025 Accepting new patients
Desoto Regional Family Medicine CurrentSince May 1, 2025 Accepting new patients
Desoto Hospital Association CurrentSince Aug 8, 2025 Accepting new patients
Lsu Health Sciences Center Shreveport Faculty Group Practice Internal Medicine CurrentSince Jul 31, 2023 Accepting new patients
Desoto Hospital Association CurrentSince May 1, 2025 Accepting new patients
Brfhh Shreveport LLC Past Accepting new patients
University Health Shreveport LLC Past Accepting new patients

Locations

130 Jefferson St
Mansfield, LA 71052
Phone (318) 872-2700

207 Jefferson St
Mansfield, LA 71052
Phone (318) 871-3109

4864 Jackson St
Monroe, LA 71202
Phone (318) 330-7000

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

1322 Kings Hwy
Fl 2
Shreveport, LA 71103
Phone (318) 626-4072

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEDHAA

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1992238695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W KIRBY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-626-0000",
            "fax_number": "318-629-4833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2150 Pennsylvania Avenue, NW",
            "address_2": "The GW Medical Faculty Associates",
            "address_purpose": "LOCATION",
            "city": "Washinton",
            "state": "DC",
            "postal_code": "20037",
            "country_code": "US",
            "telephone_number": "202-741-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYEB",
        "first_name": "TAHER",
        "middle_name": "MAMDOUH T",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "337755",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "LA",
            "license": "337755",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "337755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.