Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | Q0747 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q0747 | TX |
NPI | 1083946685 |
---|---|
Provider Name | Michel Gerges Diab |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79430-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2010 |
Last Update Date | 09/11/2021 |