Provider Demographics
NPI:1265459887
Name:ALI, TAHIR S (MD)
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-346-6009
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:SUITE 260
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3923
Practice Address - Country:US
Practice Address - Phone:817-346-6000
Practice Address - Fax:817-346-6009
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3553207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040017899OtherRAILROAD MEDICARE
TX150356705Medicaid