Provider Demographics
NPI:1003267899
Name:YOUR DOCTOR'S OFFICE, PC
Entity Type:Organization
Organization Name:YOUR DOCTOR'S OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAIKH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHIDUZZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-676-4076
Mailing Address - Street 1:8630 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8852
Mailing Address - Country:US
Mailing Address - Phone:334-676-4076
Mailing Address - Fax:334-676-4064
Practice Address - Street 1:8630 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8852
Practice Address - Country:US
Practice Address - Phone:334-676-4076
Practice Address - Fax:334-676-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty