Healthcare Provider Details

I. General information

NPI: 1013504109
Provider Name (Legal Business Name): IRFAN HAIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7784 W 11TH ST UNIT 177
TRACY CA
95304-8832
US

IV. Provider business mailing address

7784 W 11TH ST UNIT 177
TRACY CA
95304-8832
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-4250
  • Fax: 925-281-3063
Mailing address:
  • Phone: 209-900-4250
  • Fax: 925-281-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA200340
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA200340
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA200340
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA200340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: