Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA08809000 | NJ |
N | 111NI0900X | Internist | 25MA08809000 | NJ |
Y | 207RC0000X | Internist - Cardiovascular Disease | 51170 | TN |
NPI | 1013295179 |
---|---|
Provider Name | Ashraf Yahya Alqaqa |
First Address | Martin, TN 38237-3309 |
Second Address | Martin, TN 38237-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2011 |
Last Update Date | 06/09/2014 |