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General NPI Number Information
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NPI Number | 1972614436
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Entity Type | Individual
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Provider Name | SHOAB SIDDIQUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 3000 Q ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-7058
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Country | US
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Telephone | 916-733-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 DATA DR
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | A71415
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License Number State | CA
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