Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | TRN22622 | FL |
N | 111NI0900X | Internist | TRN22622 | FL |
NPI | 1003260852 |
---|---|
Provider Name | Amr Idris |
First Address | Dallas, TX 75246-2017 |
Second Address | Dallas, TX 75246-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 25/06/2019 |