Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01078460A | IN |
Y | 111NI0900X | Internist | 01078460A | IN |
N | 207R00000X | Internist | 325169 | LA |
N | 111NI0900X | Internist | 325169 | LA |
N | 207R00000X | Internist | 4301105372 | MI |
N | 111NI0900X | Internist | 4301105372 | MI |
N | 207R00000X | Internist | 85653 | SC |
N | 111NI0900X | Internist | 85653 | SC |
N | 207R00000X | Internist | MD-48355 | IA |
N | 111NI0900X | Internist | MD-48355 | IA |
N | 207R00000X | Internist | MED-PHYS-LIC-87561 | MT |
N | 111NI0900X | Internist | MED-PHYS-LIC-87561 | MT |
N | 207RA0401X | Internist - Addiction Medicine | 35134230 | OH |
NPI | 1750797262 |
---|---|
Provider Name | Jibran Durrani |
First Address | Peachtree City, GA 30269-1546 |
Second Address | Lafayette, IN 47905-4972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 22/10/2021 |