Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 04-23737 | KS |
NPI | 1114002144 |
---|---|
Provider Name | Ibrahim A Gobar |
First Address | Pittsburg, KS 66762-1266 |
Second Address | Pittsburg, KS 66762-6643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10013868A | (05) | KS |
F03276 | (02) |