Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME89652 | FL |
NPI | 1033159819 |
---|---|
Provider Name | Basher M Atiquzzaman |
First Address | Kissimmee, FL 34744-2308 |
Second Address | Kissimmee, FL 34744-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 06/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279595700 | (05) | FL |
H68378 | (02) | |
P00392759 | RR MEDICARE (01) | FL |