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General NPI Number Information
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NPI Number | 1609857341
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Entity Type | Individual
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Provider Name | EBBA K. EBBA M.D
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | CORNER OF ROUTE N12 AND N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0649
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Country | US
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Telephone | 928-729-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0649
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 36724
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 50869
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25659
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 32946
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | TP229
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License Number State | KY
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