Healthcare Provider Details

I. General information

NPI: 1336252204
Provider Name (Legal Business Name): TAUQIR X AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DEPAUL DR. SUITE 305
BRIDGETON MO
63044-2516
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-770-0991
  • Fax: 314-770-0692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2000160608
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: