Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 45263 | AZ |
N | 207RC0000X | Internist - Cardiovascular Disease | P6136 | TX |
NPI | 1003009861 |
---|---|
Provider Name | Moustafa Banna |
First Address | Glendale, AZ 85306-1869 |
Second Address | Glendale, AZ 85306-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
324413901 | (05) | TX |
324413902 | (05) | TX |