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General NPI Number Information
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NPI Number | 1104150119
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF SOUTH TEXAS, PLLC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 320 MERCEDES ST
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City | BENBROOK
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State | TX
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Zip | 76126-2593
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Country | US
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Telephone | 817-249-7323
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Fax | 817-887-2193
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Provider Business Mailing Address
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Address Line | 320 MERCEDES ST
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City | BENBROOK
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State | TX
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Zip | 76126-2593
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Country | US
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Telephone | 817-249-7323
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Fax | 817-887-2193
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUBIA SADIQ
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Credential | MD
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Telephone | 817-249-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N3283
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License Number State | TX
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