1477127744 NPI number — YAMAN GIBRAN M.D.

Table of content: YAMAN GIBRAN M.D. (NPI 1477127744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477127744 NPI number — YAMAN GIBRAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBRAN
Provider First Name:
YAMAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477127744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/07/2022
NPI Reactivation Date:
01/30/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 TREASURE HILLS BLVD, VBMC DEPT. OF MEDICINE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-296-1491
Provider Business Mailing Address Fax Number:
956-389-4603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18801-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-3801
Provider Business Practice Location Address Fax Number:
570-278-2177
Provider Enumeration Date:
05/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  BP10074648 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD482747 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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