Basic Information
| Provider Information | |||||||||
| NPI: | 1366520066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIAMATALI | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | RAMZAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E VERMONT AVE | ||||||||
| Address2: | APPT#5212 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562499564 | ||||||||
| FaxNumber: | 3083985537 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 WEST FAIDLEY | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083844600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | H5015 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 09251809 | 05 | MS | MEDICAID | 1473502 | 05 | LA | MEDICAID |