Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | N7811 | TX |
NPI | 1043473820 |
---|---|
Provider Name | Rafiul Sameer Islam |
First Address | Lubbock, TX 79424-3219 |
Second Address | Lubbock, TX 79424-3219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
670489 | (05) | AZ |