Individual
DR. SAJJUDAL ISLAM SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G7240
TX
2085R0202X
Diagnostic Radiology Physician
Primary
G7240
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00GE62
BLUE CROSS OF TEXAS
TX
05
—
120388704
—
TX
01
—
G7240
WORK COMP
TX
Enumeration date
08/10/2005
Last updated
04/30/2012
Update your record
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