Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2000159814 | MO |
N | 207P00000X | Emergency Physician | K1966 | TX |
NPI | 1003847591 |
---|---|
Provider Name | Nagla Abdelmalek |
First Address | Saint Louis, MO 63105-2945 |
Second Address | Saint Louis, MO 63136-6119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 28/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205006802 | (05) | MO |
G55727 | (02) |