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1548394414 NPI number — KHALED MUSTAFA GHORAB MD

NPI Number: 1548394414
Health Care Provider/Practitioner: KHALED MUSTAFA GHORAB MD

Information about “1548394414” NPI (KHALED MUSTAFA GHORAB MD) exists in 1548394414 in HTML format HTML  |  1548394414 in plain Text format TXT  |  1548394414 in PDF (Portable Document Format) PDF  |  1548394414 in an XML format XML  formats.

NPI Number : 1548394414 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548394414",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GHORAB",
    "FirstName": "KHALED",
    "MiddleName": "MUSTAFA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "700 S 6TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEESVILLE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71446-4719",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "337-238-6161",
    "MailingAddressFaxNumber": "337-238-0085",
    "FirstLinePracticeLocationAddress": "700 S 6TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEESVILLE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "71446-4719",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "337-238-6161",
    "PracticeLocationAddressFaxNumber": "337-238-0085",
    "EnumerationDate": "03/15/2007",
    "LastUpdateDate": "07/15/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "202557",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "C7-0003294",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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