Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | S9839 | TX |
NPI | 1255860177 |
---|---|
Provider Name | Amira Rose Alkhatib |
First Address | Beaumont, TX 77701-4633 |
Second Address | Beaumont, TX 77701-4688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 20/10/2021 |