Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | K6658 | TX |
NPI | 1003839747 |
---|---|
Provider Name | Jamal Mubarak |
First Address | Denton, TX 76201-3708 |
Second Address | Denton, TX 76201-3708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029817601 | (05) | TX |
G83886 | (02) | TX |