Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D89424 | MD |
N | 111NI0900X | Internist | D89424 | MD |
Y | 207RG0100X | Gastroenterologist | 69024 | MN |
NPI | 1043605108 |
---|---|
Provider Name | Shaz Iqbal |
First Address | Middle River, MD 21220-2004 |
Second Address | Coon Rapids, MN 55433-5886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2015 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D89424 | LICENSE (01) | MD |