Provider Demographics
NPI:1992723605
Name:LABIB, BISHOY (MD)
Entity type:Individual
Prefix:
First Name:BISHOY
Middle Name:
Last Name:LABIB
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:PO BOX 10239
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92255-0239
Mailing Address - Country:US
Mailing Address - Phone:760-779-1177
Mailing Address - Fax:760-779-0099
Practice Address - Street 1:72670 FRED WARING DR
Practice Address - Street 2:STE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-5012
Practice Address - Country:US
Practice Address - Phone:760-779-1177
Practice Address - Fax:760-779-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA798462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149988001Medicaid
AR149988001Medicaid
AR5M548Medicare ID - Type Unspecified