Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | P1199 | TX |
N | 111NI0900X | Internist | P1199 | TX |
Y | 207RN0300X | Nephrologist | 4301079766 | MI |
N | 207RN0300X | Nephrologist | P1199 | TX |
N | 208000000X | Pediatrician | 4301079766 | MI |
N | 2080P0210X | Pediatric Nephrologist | 4301079766 | MI |
N | 2080P0210X | Pediatric Nephrologist | P1199 | TX |
NPI | 1952582157 |
---|---|
Provider Name | Mr. Imran Adam Memon |
First Address | Fort Worth, TX 76104-3029 |
Second Address | Fort Worth, TX 76104-2228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2007004327 | MISSOURI LICENSE NUMBER (01) | MO |
290375YSE6 | (02) | TX |
321658201 | (05) | TX |
BM9700469 | DEA NUMBER (01) | MO |
FM3786211 | DEA (01) | TX |
N0195877 | DPS (01) | TX |
P1199 | TEXAS LICENSE (01) | TX |