Individual provider · NPI-1

Dr. Ibrahim Abdalla, M.D.

· Springfield, MO

NPI number1437154630
StatusActive
Last updated in NPPESFeb 12, 2013

Details

NPI
1437154630
Entity type
Individual (NPI-1)
Name
Dr. Ibrahim Abdalla
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Jun 15, 2005
Last updated
Feb 12, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2085R0001X 2000158663MOYes
174400000X Specialist2000158663MO

Practice location

3850 S National Ave
Ste 100
Springfield, MO 65807-5287

Phone 417-269-8926 · Fax 417-269-5371

Mailing address

Po Box 9007
Ste 100
Springfield, MO 65808-9007

Phone 417-269-8926 · Fax 417-269-5371

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