Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME-21556 | FL |
NPI | 1043218399 |
---|---|
Provider Name | Dabir A Siddiqui |
First Address | Winter Haven, FL 33880-3053 |
Second Address | Winter Haven, FL 33880-3053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D56521 | (02) | FL |