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1407425416 NPI number — MOHAMMED QUSSAY ALI AL-SABBAGH M.D.

NPI Number: 1407425416
Health Care Provider/Practitioner: MOHAMMED QUSSAY ALI AL-SABBAGH M.D.

Information about “1407425416” NPI (MOHAMMED QUSSAY ALI AL-SABBAGH M.D.) exists in 1407425416 in HTML format HTML  |  1407425416 in plain Text format TXT  |  1407425416 in PDF (Portable Document Format) PDF  |  1407425416 in an XML format XML  formats.

NPI Number : 1407425416 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407425416",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AL-SABBAGH",
    "FirstName": "MOHAMMED",
    "MiddleName": "QUSSAY ALI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "660 S EUCLID AVE",
    "SecondLineMailingAddress": "CAMPUS BOX 8111",
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63110-1010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4921 PARKVIEW PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63110-1032",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-362-7382",
    "PracticeLocationAddressFaxNumber": "314-747-3342",
    "EnumerationDate": "06/23/2021",
    "LastUpdateDate": "06/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/13/2022",
    "NPIReactivationDate": "12/20/2022",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084N0400X",
        "TaxonomyName": "Neurology Physician",
        "LicenseNumber": "2025002975",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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