Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD39717 | TN |
NPI | 1003880295 |
---|---|
Provider Name | Dr. Tariq Ziad Haddadin |
First Address | Johnson City, TN 37604-6008 |
Second Address | Johnson City, TN 37604-6008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003880295 | (05) | VA |
1508463 | (05) | TN |
I27120 | (02) | |
P01206451 | RAILROAD MEDICARE (01) | TN |