Provider Demographics
NPI:1639323173
Name:SADIQ, RUBIA (MD)
Entity type:Individual
Prefix:DR
First Name:RUBIA
Middle Name:
Last Name:SADIQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUBIA
Other - Middle Name:
Other - Last Name:SADIQ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:320 MERCEDES ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2593
Mailing Address - Country:US
Mailing Address - Phone:817-249-7323
Mailing Address - Fax:817-249-7339
Practice Address - Street 1:320 MERCEDES STREET
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126
Practice Address - Country:US
Practice Address - Phone:817-249-7323
Practice Address - Fax:817-249-7339
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091494207R00000X
TXN3283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23215Medicare PIN