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General NPI Number Information
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NPI Number | 1710907613
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Entity Type | Organization
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Legal Business Name | QAISAR J QAYYUM MD, PC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 13974 S BROADWAY
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City | EDMOND
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State | OK
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Zip | 73034-8144
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Country | US
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Telephone | 405-562-8715
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Fax | 405-562-8717
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Provider Business Mailing Address
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Address Line | PO BOX 31195
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City | EDMOND
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State | OK
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Zip | 73003
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Country | US
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Telephone | 405-562-8715
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. QAISAR J QAYYUM
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Credential | MD
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Telephone | 405-562-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 21912
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License Number State | OK
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