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General NPI Number Information
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NPI Number | 1568691764
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Entity Type | Organization
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Legal Business Name | W. NOUBANI, PA MEDICAL PLLC
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 6407 S COOPER ST 117
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City | ARLINGTON
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State | TX
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Zip | 76001-6795
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Country | US
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Telephone | 817-472-7601
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Fax | 817-472-7213
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Provider Business Mailing Address
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Address Line | 6407 S COOPER ST 117
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City | ARLINGTON
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State | TX
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Zip | 76001-6795
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Country | US
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Telephone | 817-472-7601
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Fax | 817-472-7213
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Authorized Official
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Title or Position | OWNER
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Name | MR. WISSAM NOUBANI
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Credential |
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Telephone | 817-472-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA03902
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License Number State | TX
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