Provider Demographics
NPI:1578883336
Name:SIDDIQUI, JAMAL DEAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:DEAN
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2000 S WHEELING AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5642
Mailing Address - Country:US
Mailing Address - Phone:918-747-3937
Mailing Address - Fax:918-748-8707
Practice Address - Street 1:7171 S YALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6367
Practice Address - Country:US
Practice Address - Phone:918-747-3937
Practice Address - Fax:918-748-8707
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2020-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RILP02002207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology