Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 07137R | LA |
Y | 208200000X | Surgeon | 07137R | LA |
Y | 208600000X | Surgeon | 07137R | LA |
NPI | 1497775282 |
---|---|
Provider Name | Gazi Baderkhan Zibari |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1972207 | (05) | LA |
E94113 | (02) | LA |