Individual
GIBRAN HAMID MAHMUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1052 M L KING DR, SUITE 2, CENTRALIA, IL 62801-3002
(618) 436-5410
(618) 436-8063
Mailing address
1052 M L KING DR, SUITE 2, CENTRALIA, IL 62801-3002
(618) 436-5410
(618) 436-8063
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2011020105
MO
207RH0003X
Hematology & Oncology Physician
Primary
2011020105
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518132489
—
IL
05
—
1518132489
—
MO
Enumeration date
04/23/2008
Last updated
12/05/2016
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