Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301096862 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 51522 | AZ |
NPI | 1134431760 |
---|---|
Provider Name | Dr. Mohamed Nagiub |
First Address | Yuma, AZ 85366 |
Second Address | Roanoke, VA 24018-0720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 02/11/2021 |