Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036146028 | IL |
N | 111NI0900X | Internist | 036146028 | IL |
NPI | 1003292624 |
---|---|
Provider Name | Mohammed Guba |
First Address | Carbondale, IL 62902-3988 |
Second Address | Murphysboro, IL 62966-3333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214881 | GROUP PTAN (01) | IL |