Abdalla, Ibrahim

Abdalla, Ibrahim is an individual health care provider with primary practice located at 3850 S National Ave Ste 100, Springfield MO 65807-5287. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Radiation Oncology. Allopathic & Osteopathic Physicians / Radiation Oncology is his primary health care specialty. Abdalla, Ibrahim can be contacted via phone (417) 269-8926.

Contact Information

Primary practice address
3850 S National Ave Ste 100 Springfield MO 65807-5287
Phone: (417) 269-8926
Fax: (417) 269-5371
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 2000158663 Missouri
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 2000158663 Missouri

Profile Details

NPI number 1437154630
LBN Legal business name Abdalla, Ibrahim
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2005
Last updated Feb 12th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437154630 NPPES
Missouri Other 148380070 MEDICARE PTAN
Missouri MEDICAID 205070303 MEDICARE PTAN

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