Provider Demographics
NPI:1083038939
Name:TAHIR, MANSOOR AHMED (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MANSOOR
Middle Name:AHMED
Last Name:TAHIR
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3161 N ROCK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1312
Mailing Address - Country:US
Mailing Address - Phone:316-440-2713
Mailing Address - Fax:316-260-6897
Practice Address - Street 1:3161 N ROCK RD
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1312
Practice Address - Country:US
Practice Address - Phone:316-440-2713
Practice Address - Fax:316-260-6897
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant