Provider Demographics
NPI:1669579140
Name:KHEIRALLA, SABER IBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:SABER
Middle Name:IBRAHIM
Last Name:KHEIRALLA
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 1:510 E. STONER ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPOLRT
Mailing Address - State:LA
Mailing Address - Zip Code:71110
Mailing Address - Country:US
Mailing Address - Phone:318-221-8411
Mailing Address - Fax:318-429-5752
Practice Address - Street 1:510 E. STONER ST
Practice Address - Street 2:
Practice Address - City:SHREVEPOLRT
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-429-5752
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63533207R00000X
AL00020725207R00000X
PAMD067455L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine