MEDICARE: TAHIR S ALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	L3553	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040017899	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265459887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHIR S ALI MD

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-346-6009

Provider Business Practice Location Address
First Line	:	5801 OAKBEND TRL
Second Line	:	SUITE 260
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3923
Country	:	US
Telephone Number	:	817-346-6000
Fax Number	:	817-346-6009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/01/2012

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Directions to “ TAHIR S ALI MD” Practice Location

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