Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0090 | NC |
N | 1223P0700X | Prosthodontist | 2640 | ZZ |
NPI | 1255578373 |
---|---|
Provider Name | Dr. Ibrahim Duqum |
First Address | Chapel Hill, NC 27599-0001 |
Second Address | Chapel Hill, NC 27599-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2009 |
Last Update Date | 12/01/2009 |