Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | E-8381 | AR |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | E-8381 | AR |
NPI | 1215284187 |
---|---|
Provider Name | Humza Feroz Siddiqi |
First Address | Little Rock, AR 72212-4417 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 05/10/2016 |