Provider Demographics
NPI:1538460951
Name:MIR, MUHAMMAD QASIM SALAR (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:QASIM SALAR
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 S 74TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5155
Mailing Address - Country:US
Mailing Address - Phone:479-314-4620
Mailing Address - Fax:479-314-4630
Practice Address - Street 1:2713 S 74TH ST STE 301
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5155
Practice Address - Country:US
Practice Address - Phone:479-314-4620
Practice Address - Fax:479-314-4630
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49050207RP1001X
MO2019005581207RP1001X
IL036141573207RP1001X
ARE13331207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004233Medicaid
TN1530250Medicaid
TN103I709771Medicare PIN
TN1530250Medicaid