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General NPI Number Information
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NPI Number | 1487821708
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Entity Type | Organization
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Legal Business Name | M. TAHIR QAYYUM, MD, PMC
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 540 DURHAM STREET
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City | BASTROP
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State | LA
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Zip | 71220
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Country | US
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Telephone | 318-283-2200
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Fax | 318-283-1200
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Provider Business Mailing Address
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Address Line | 540 DURHAM ST
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City | BASTROP
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State | LA
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Zip | 71220-5013
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Country | US
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Telephone | 318-283-2200
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Fax | 318-283-1200
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Authorized Official
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Title or Position | OWNER
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Name | DR. M. TAHIR QAYYUM
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Credential | M.D.
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Telephone | 318-283-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 10850R
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License Number State | LA
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