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General NPI Number Information
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NPI Number | 1578883336
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Entity Type | Individual
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Provider Name | JAMAL DEAN SIDDIQUI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 7171 S YALE AVE STE 103
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City | TULSA
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State | OK
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Zip | 74136-6367
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Country | US
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Telephone | 918-747-3937
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Fax | 918-748-8707
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Provider Business Mailing Address
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Address Line | 2000 S WHEELING AVE STE 500
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City | TULSA
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State | OK
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Zip | 74104-5642
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Country | US
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Telephone | 918-747-3937
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Fax | 918-748-8707
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | LP02002
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License Number State | RI
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