Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | N0747 | TX |
N | 208000000X | Pediatrician | N0747 | TX |
NPI | 1386942407 |
---|---|
Provider Name | Ayman W El-Hattab |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65201-6986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2011 |
Last Update Date | 16/08/2011 |