Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | R9942 | MO |
NPI | 1013933415 |
---|---|
Provider Name | Dr. Laila G. Gabrawy |
First Address | Saint Louis, MO 63112-4265 |
Second Address | Saint Louis, MO 63112-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201543600 | (05) | MO |
A24491 | (02) |