Provider Demographics
NPI:1568691764
Name:W. NOUBANI, PA MEDICAL PLLC
Entity Type:Organization
Organization Name:W. NOUBANI, PA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-472-7601
Mailing Address - Street 1:6407 S COOPER ST
Mailing Address - Street 2:117
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6795
Mailing Address - Country:US
Mailing Address - Phone:817-472-7601
Mailing Address - Fax:817-472-7213
Practice Address - Street 1:6407 S COOPER ST
Practice Address - Street 2:117
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6795
Practice Address - Country:US
Practice Address - Phone:817-472-7601
Practice Address - Fax:817-472-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03902363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty