Provider Demographics
NPI:1366520066
Name:NIAMATALI, GORDON RAMZAN (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:RAMZAN
Last Name:NIAMATALI
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 1:1000 E VERMONT AVE
Mailing Address - Street 2:APPT#5212
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1717
Mailing Address - Country:US
Mailing Address - Phone:956-249-9564
Mailing Address - Fax:308-398-5537
Practice Address - Street 1:2620 WEST FAIDLEY
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-384-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5015207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09251809Medicaid
LA1473502Medicaid
MS09251809Medicaid
MS512I050096Medicare PIN