Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R5348 | TX |
NPI | 1003022898 |
---|---|
Provider Name | Nusrat Ahmed |
First Address | Freeport, TX 77541-3907 |
Second Address | Freeport, TX 77541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G02601 | (02) |