Provider Demographics
NPI:1417679192
Name:BARBACHAN MANSUR, NACIME SALOMAO (MD, PHD)
Entity Type:Individual
Prefix:
First Name:NACIME SALOMAO
Middle Name:
Last Name:BARBACHAN MANSUR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 5TH ST APT 217
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2350
Mailing Address - Country:US
Mailing Address - Phone:319-400-7911
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR DEPT OF
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT-1185207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT-1185OtherBOARD NUMBER