MEDICARE: YOUR DOCTOR'S OFFICE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	24787	AL

General Provider Information

NPI Number	:	1003267899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR DOCTOR'S OFFICE, PC

Provider Business Mailing Address
First Line	:	8630 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8852
Country	:	US
Telephone Number	:	334-676-4076
Fax Number	:	334-676-4064

Provider Business Practice Location Address
First Line	:	8630 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8852
Country	:	US
Telephone Number	:	334-676-4076
Fax Number	:	334-676-4064

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	DR. SHAIKH WAHIDUZZAMAN
Credential	:	M.D.
Telephone Number	:	334-676-4076

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	10/31/2016

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