Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | R2122 | TX |
NPI | 1174818785 |
---|---|
Provider Name | Tariq Khalid Hendawi |
First Address | Arlington, TX 76015-3604 |
Second Address | Arlington, TX 76015-3604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 06/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
373540902 | (05) | TX |