Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | P0750 | TX |
NPI | 1093935975 |
---|---|
Provider Name | Alim Mirza Ladha |
First Address | Odessa, TX 79768-3562 |
Second Address | Odessa, TX 79765-8615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 28/10/2016 |