Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036137242 | IL |
NPI | 1063606432 |
---|---|
Provider Name | Dr. Mohammed Al-Zoubaidi |
First Address | Saint Louis, MO 63195-1105 |
Second Address | Mount Vernon, IL 62864-2476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 19/10/2020 |