Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301106561 | MI |
N | 207N00000X | Dermatologist | MD17679 | HI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2019-01570 | NC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 4301106561 | MI |
N | 207ND0101X | MOHS-Micrographic Surgeon | 49483 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD17679 | HI |
N | 207NS0135X | Procedural Dermatology | A125540 | CA |
NPI | 1154565661 |
---|---|
Provider Name | Bishr Al Dabagh |
First Address | Mooresville, NC 28117-6542 |
Second Address | Mooresville, NC 28117-6542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 08/05/2021 |