Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | R5346 | MO |
NPI | 1013997790 |
---|---|
Provider Name | Mr. Hisham S Majzoub |
First Address | Joplin, MO 64804-1564 |
Second Address | Joplin, MO 64804-1564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100156210E | (05) | KS |
100194410A | (05) | OK |
200708303 | (05) | MO |
A11982 | (02) |