Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | L0284 | TX |
NPI | 1003893462 |
---|---|
Provider Name | Mir Tajammul Hussain |
First Address | Dallas, TX 75265-0865 |
Second Address | Dallas, TX 75240-6524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 28/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050075369 | RAILROAD (01) | TX |
118185101 | (05) | TX |
118185105 | (05) | TX |
118185106 | (05) | TX |
118185107 | (05) | TX |
118185108 | (05) | TX |
118185109 | (05) | TX |
8A0490 | BLUE CROSS BLUE SHILED (01) | TX |
8EH271 | BCBS TX (01) | TX |
G97216 | (02) |