Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2011024426 | MO |
N | 111NI0900X | Internist | 2011024426 | MO |
N | 207R00000X | Internist | Q3596 | TX |
N | 111NI0900X | Internist | Q3596 | TX |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | Q3596 | TX |
NPI | 1093967838 |
---|---|
Provider Name | Asmat Qayoom Siddiqi |
First Address | Dallas, TX 75284-4658 |
Second Address | Killeen, TX 76543-5252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2008 |
Last Update Date | 09/03/2021 |