Healthcare Provider Details

I. General information

NPI: 1114904323
Provider Name (Legal Business Name): AMR ABD-AL-GHAFFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

IV. Provider business mailing address

528 OKANOGAN AVE
WENATCHEE WA
98801-2974
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-8711
  • Fax:
Mailing address:
  • Phone: 814-838-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD051516L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: