Healthcare Provider Details

I. General information

NPI: 1366520066
Provider Name (Legal Business Name): GORDON RAMZAN NIAMATALI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WEST FAIDLEY
GRAND ISLAND NE
68803
US

IV. Provider business mailing address

1000 E VERMONT AVE APPT#5212
MCALLEN TX
78503-1717
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-4600
  • Fax:
Mailing address:
  • Phone: 956-249-9564
  • Fax: 308-398-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH5015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: