1235186099 NPI number — DR. RIAZ AHMED SIRAJUDDIN M.D.

Table of content: DR. RIAZ AHMED SIRAJUDDIN M.D. (NPI 1235186099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235186099 NPI number — DR. RIAZ AHMED SIRAJUDDIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRAJUDDIN
Provider First Name:
RIAZ
Provider Middle Name:
AHMED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIRAJUDDIN
Provider Other First Name:
RIAZ
Provider Other Middle Name:
AHMED
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235186099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10413 GREENBRIAR PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73159-6923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-691-4665
Provider Business Mailing Address Fax Number:
405-378-7628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10413 GREENBRIAR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73159-7656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-691-4665
Provider Business Practice Location Address Fax Number:
405-378-7628
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  22726 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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