Provider Demographics
NPI:1154322923
Name:ATWI, JIBRAN ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JIBRAN
Middle Name:ELIAS
Last Name:ATWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2308 E MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4041
Mailing Address - Country:US
Mailing Address - Phone:337-367-2001
Mailing Address - Fax:337-365-3050
Practice Address - Street 1:401 YOUNGSVILLE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5173
Practice Address - Country:US
Practice Address - Phone:337-330-0031
Practice Address - Fax:337-330-0059
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10447R208000000X, 207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1988791Medicaid
LA5U457Medicare ID - Type Unspecified
F19193Medicare UPIN