Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | J6136 | TX |
NPI | 1023073665 |
---|---|
Provider Name | Mr. Karim S Jamal |
First Address | Fort Worth, TX 76132-4524 |
Second Address | Fort Worth, TX 76134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0071JE | BLUE CROSS BLUE SHIELD (01) | TX |
135343509 | (05) | TX |
135343510 | (05) | TX |
F86912 | (02) | TX |