Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | L3469 | TX |
NPI | 1053374769 |
---|---|
Provider Name | Ibrahim Adly Shalaby |
First Address | Lubbock, TX 79410-1121 |
Second Address | Lubbock, TX 79410-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 20/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148319001 | (05) | TX |
H53101 | (02) |