Provider Demographics
NPI:1114002144
Name:GOBAR, IBRAHIM A (MD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:A
Last Name:GOBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1266
Mailing Address - Country:US
Mailing Address - Phone:620-232-0273
Mailing Address - Fax:620-231-0081
Practice Address - Street 1:1102 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6643
Practice Address - Country:US
Practice Address - Phone:620-232-0273
Practice Address - Fax:620-231-0081
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23737207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10013868AMedicaid
KS10013868AMedicaid
F03276Medicare UPIN