Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2003009742 | MO |
N | 207T00000X | Neurosurgeon | 27832 | OK |
N | 207T00000X | Neurosurgeon | 31394 | KY |
NPI | 1053345231 |
---|---|
Provider Name | Dr. Bassam Ar Hadi |
First Address | Saint Louis, MO 63128-2197 |
Second Address | Saint Louis, MO 63128-2197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 11/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000525779 | BLUECROSS (01) | KY |
200316690A | (05) | OK |
3321859 | (02) | KY |
64016272 | (05) | KY |
6401627200 | (05) | KY |
G16856 | (02) | MO |
OKAAA0265 | (02) | OK |
P00732227 | MEDICARE PTAN (01) | KY |