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General NPI Number Information
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NPI Number | 1639171887
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Entity Type | Individual
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Provider Name | MOHAMMAD JAVED TARIQ MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 1850 LAKEPOINTE STE 100
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City | LEWISVILLE
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State | TX
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Zip | 75057
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Country | US
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Telephone | 972-316-3344
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Fax | 972-316-3322
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Provider Business Mailing Address
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Address Line | 6505 W. PK BLV STE 306,PMB 376
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City | PLANO
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State | TX
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Zip | 75093
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Country | US
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Telephone | 972-316-3344
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Fax | 972-316-3322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | K1092
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | K1092
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | K1092
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D2018771
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License Number State | TX
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