Healthcare Provider Details

I. General information

NPI: 1780909739
Provider Name (Legal Business Name): ZAIBA IQBAL JETPURI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HARRY HINES BLVD GRADUATE MEDICAL EDUCATION
DALLAS TX
75235-7708
US

IV. Provider business mailing address

5909 HARRY HINES BLVD SUITE 100, MC 9067
DALLAS TX
75390-9067
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP6192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: