=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215077482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAQAR AHMAD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 01/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 N 11TH ST, SUITE D1001 CHRISTUS ST. ELIZABETH WOUND CARE/HYPERBARICS
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-924-6975
-----------------------------------------------------
Fax | 409-899-8204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7465 PRESTWICK CIR
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77707-5438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-923-1650
-----------------------------------------------------
Fax | 409-923-1651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 24488
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | N2363
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------