=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528234044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TASLIMA A KARIM PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 503 MEDICAL CENTER BLVD SUITE 100
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-788-1060
-----------------------------------------------------
Fax | 936-788-2844
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 MEDICAL CENTER BLVD SUITE 100
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-788-1060
-----------------------------------------------------
Fax | 936-788-2844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA04221
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------