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General NPI Number Information
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NPI Number | 1508025792
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Entity Type | Individual
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Provider Name | LIBAN ABDI RODOL MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 9601 STEILACOOM BLVD SW
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City | TACOMA
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State | WA
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Zip | 98498-7212
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Country | US
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Telephone | 206-879-7925
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 STEILACOOM BLVD SW
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City | TACOMA
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State | WA
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Zip | 98498-7212
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Country | US
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Telephone | 206-879-7925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD60124726
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | MD60124726
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License Number State | WA
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