1376957605 NPI number — DR. EZDEHAR GHANDOURAH PDS, MCS, FACP

Table of content: DR. EZDEHAR GHANDOURAH PDS, MCS, FACP (NPI 1376957605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376957605 NPI number — DR. EZDEHAR GHANDOURAH PDS, MCS, FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHANDOURAH
Provider First Name:
EZDEHAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PDS, MCS, FACP
Provider Gender Code:
F

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:
1376957605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O.BOX 93098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIYADH
Provider Business Mailing Address State Name:
CENTRAL REGION
Provider Business Mailing Address Postal Code:
11673
Provider Business Mailing Address Country Code:
SA
Provider Business Mailing Address Telephone Number:
00966500003705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AL IMAM TURKI IBN ABDULLAH IBN MUHAMMAD, ULAISHAH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIYADH
Provider Business Practice Location Address State Name:
CENTRAL REGION
Provider Business Practice Location Address Postal Code:
12746
Provider Business Practice Location Address Country Code:
SA
Provider Business Practice Location Address Telephone Number:
00966114355555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2014

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: 1223P0700X , with the licence number:  06-R-D-23338 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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