Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | L6464 | TX |
NPI | 1003878281 |
---|---|
Provider Name | Asif Zia Khattak |
First Address | Richardson, TX 75082-3757 |
Second Address | Dallas, TX 75246-2096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 08/07/2007 |