Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 29331 | OK |
N | 207RG0300X | Geriatric Medicine | 2008020462 | MO |
NPI | 1053567644 |
---|---|
Provider Name | Saad Basheer |
First Address | Broken Arrow, OK 74012-4906 |
Second Address | Broken Arrow, OK 74012-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 16/12/2021 |