Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | M4944 | TX |
NPI | 1023107208 |
---|---|
Provider Name | Farrah N Siddiqui |
First Address | Galveston, TX 77555-0521 |
Second Address | Galveston, TX 77555-0521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I72720 | (02) | TX |