Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | BP10053894 | TX |
Y | 111NI0900X | Internist | BP10053894 | TX |
NPI | 1003296690 |
---|---|
Provider Name | Zehra Hussain |
First Address | Longview, TX 75601-5580 |
Second Address | Longview, TX 75601-5580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2015 |
Last Update Date | 09/06/2015 |