Healthcare Provider Details

I. General information

NPI: 1972549251
Provider Name (Legal Business Name): OBAID A SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 GROVELAND RD
OCEAN SPRINGS MS
39564-5753
US

IV. Provider business mailing address

3650 GROVELAND RD
OCEAN SPRINGS MS
39564-5753
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-0780
  • Fax: 228-875-1009
Mailing address:
  • Phone: 228-875-0780
  • Fax: 228-875-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14585
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: