Provider Demographics
NPI:1083767560
Name:ABDALLA A. TAHIRI, M.D.,P.A.
Entity Type:Organization
Organization Name:ABDALLA A. TAHIRI, M.D.,P.A.
Other - Org Name:LITTLE ROCK GASTROENTEROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-217-8500
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:STE 1070
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-217-8500
Mailing Address - Fax:
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:STE 1070
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-217-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115826001Medicaid
AR115826001Medicaid
AR53094Medicare PIN