Individual
DR. IBRAHIM ABDALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3850 S NATIONAL AVE, STE 100, SPRINGFIELD, MO 65807-5287
(417) 269-8926
(417) 269-5371
Mailing address
PO BOX 9007, STE 100, SPRINGFIELD, MO 65808-9007
(417) 269-8926
(417) 269-5371
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2000158663
MO
2085R0001X
Radiation Oncology Physician
Primary
2000158663
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148380070
MEDICARE PTAN
MO
05
—
205070303
—
MO
Enumeration date
06/15/2005
Last updated
02/12/2013
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