Basic Information
| Provider Information | |||||||||
| NPI: | 1386942407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EL-HATTAB | ||||||||
| FirstName: | AYMAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7687 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652057687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738826921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 N KEENE ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738826921 | ||||||||
| FaxNumber: | 5738821154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2011 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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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 | 207SG0201X | N0747 | TX | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 208000000X | N0747 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.