{
"Npi": {
"NPI": "1487821708",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "M. TAHIR QAYYUM, MD, PMC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "540 DURHAM ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BASTROP",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71220-5013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-283-2200",
"MailingAddressFaxNumber": "318-283-1200",
"FirstLinePracticeLocationAddress": "540 DURHAM STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BASTROP",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71220",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-283-2200",
"PracticeLocationAddressFaxNumber": "318-283-1200",
"EnumerationDate": "05/15/2008",
"LastUpdateDate": "10/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "QAYYUM",
"AuthorizedOfficialFirstName": "M.",
"AuthorizedOfficialMiddleName": "TAHIR",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "318-283-2200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "10850R",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}