MEDICARE: ALI ABDUL WAHID MD

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	MD432706	PA
2	207Q00000X	Family Medicine Physician	2007034473	MO
3	207Q00000X	Family Medicine Physician	A106703	CA

General Provider Information

NPI Number	:	1679767925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ABDUL WAHID MD

Provider Business Mailing Address
First Line	:	1108 WARD AVE BLDG A STE 1
Second Line	:
City	:	PATTERSON
State	:	CA
Zip	:	95363
Country	:	US
Telephone Number	:	209-892-1300
Fax Number	:	209-780-4141

Provider Business Practice Location Address
First Line	:	1108 WARD AVE
Second Line	:	BLDG A
City	:	PATTERSON
State	:	CA
Zip	:	95363-8529
Country	:	US
Telephone Number	:	209-892-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	06/30/2017

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