=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255344131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALI F ABDELAAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 12/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 N. MAIN CLAUDE PARRISH CANCER CENTER
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-365-0223
-----------------------------------------------------
Fax | 870-365-0227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 N. MAIN
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-365-0223
-----------------------------------------------------
Fax | 870-365-0227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | E0054
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E0054
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | E0054
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------