Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 34597 | AZ |
NPI | 1124079546 |
---|---|
Provider Name | Shabib A Alhadheri |
First Address | Gilbert, AZ 85233-5191 |
Second Address | Chandler, AZ 85225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 27/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BA9497593 | DEA NUMBER (01) |