Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036114868 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD2013-0055 | NM |
NPI | 1023096096 |
---|---|
Provider Name | Azim Saquib |
First Address | Las Cruces, NM 88006-6310 |
Second Address | Las Cruces, NM 88011-8128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010032057 | BCBS OF IL (01) | IL |
0361148682 | (05) | IL |
E66839 | (02) |