Healthcare Provider Details

I. General information

NPI: 1821188939
Provider Name (Legal Business Name): AREF KABBARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W APACHE ST
FARMINGTON NM
87401-5501
US

IV. Provider business mailing address

810 W APACHE ST
FARMINGTON NM
87401-5501
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-7738
  • Fax:
Mailing address:
  • Phone: 505-327-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number81-238
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: