Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R73475 | AZ |
NPI | 1003170077 |
---|---|
Provider Name | Dr. Umar Iqbal |
First Address | Phoenix, AZ 85013-4102 |
Second Address | Phoenix, AZ 85013-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 25/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R73475 | TRAINING PERMIT (01) | AZ |