Provider Demographics
NPI:1164589362
Name:MAAYTAH, TAGHREED N (MD)
Entity Type:Individual
Prefix:
First Name:TAGHREED
Middle Name:N
Last Name:MAAYTAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S SONCY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6405
Mailing Address - Country:US
Mailing Address - Phone:806-353-7900
Mailing Address - Fax:806-353-8321
Practice Address - Street 1:3501 S SONCY RD STE 102
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-353-7900
Practice Address - Fax:806-353-8321
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ91842080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752736163OtherTAX ID
TX110606402Medicaid