Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 14768 | MS |
NPI | 1013024322 |
---|---|
Provider Name | Ashraf E Riad |
First Address | Jackson, MS 39296-4507 |
Second Address | Mccomb, MS 39648-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116932 | (05) | MS |
F61058 | (02) | MS |