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Individual

ASHFAQ H SIDDIQUI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD FACS

Contact information

Practice address
309 REGENCY PKWY, SUITE 207, MANSFIELD, TX 76063-5165
(817) 225-2716
(817) 225-2719
Mailing address
309 REGENCY PKWY, SUITE 207, MANSFIELD, TX 76063-5165
(817) 225-2716
(817) 225-2719

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
L5562
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0057PA
BCBS
TX
01
1488594
AETNA
TX
05
1919615
TX
01
P00439527
RR MEDICARE
TX
Enumeration date
06/15/2005
Last updated
05/03/2021
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