Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 10447R | LA |
N | 208000000X | Pediatrician | 10447R | LA |
NPI | 1154322923 |
---|---|
Provider Name | Dr. Jibran Elias Atwi |
First Address | New Iberia, LA 70560-4041 |
Second Address | Lafayette, LA 70508-5173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1988791 | (05) | LA |
F19193 | (02) |