Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 00027426 | AL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 27426 | AL |
NPI | 1174569859 |
---|---|
Provider Name | Ibrahim Robert Hanna |
First Address | Birmingham, AL 35283-0605 |
Second Address | Birmingham, AL 35211-1323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 18/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BH9777535 | FEDERAL DEA (01) | AL |
STATE LICENSE | 00027426 (01) | AL |