Provider Demographics
NPI:1124202767
Name:TAHER, ALAEDDIN M (CCP)
Entity Type:Individual
Prefix:MR
First Name:ALAEDDIN
Middle Name:M
Last Name:TAHER
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:MR
Other - First Name:AL
Other - Middle Name:
Other - Last Name:TAHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCP
Mailing Address - Street 1:622 MATHIS MDW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4344
Mailing Address - Country:US
Mailing Address - Phone:210-882-2128
Mailing Address - Fax:
Practice Address - Street 1:622 MATHIS MDW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4344
Practice Address - Country:US
Practice Address - Phone:210-882-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0466242T00000X
IL242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist