Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 36327-20 | WI |
NPI | 1225549991 |
---|---|
Provider Name | Dr. Tawfiq Ansari |
First Address | Durham, NC 27712-8971 |
Second Address | Durham, NC 27712-8971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2017 |
Last Update Date | 16/06/2018 |