Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6810 | NE |
N | 111NI0900X | Internist | 6810 | NE |
N | 207RN0300X | Nephrologist | 036.137893 | IL |
Y | 207RN0300X | Nephrologist | 11301A | WY |
NPI | 1013271535 |
---|---|
Provider Name | Omar Al Dhaybi |
First Address | Cheyenne, WY 82003-7020 |
Second Address | Cheyenne, WY 82001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 13/07/2018 |