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General NPI Number Information
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NPI Number | 1336398833
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Entity Type | Individual
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Provider Name | ABU TAHER SIDDIQUI M.D.,
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Gender | Male
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 10000 BAY PINE BLVD BAY PINE VA HEALTH CARE SYSTEM
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City | BAY PINE
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 BAY PIINE BLVD BAY PINE VA HEALTH CARE SYSTEM
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City | BAY PINE
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME102882
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License Number State | FL
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