Provider Demographics
NPI:1639171887
Name:TARIQ, MOHAMMAD JAVED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:JAVED
Last Name:TARIQ
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 1:6505 W. PK BLV STE 306,PMB 376
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-316-3344
Mailing Address - Fax:972-316-3322
Practice Address - Street 1:1850 LAKEPOINTE STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:972-316-3344
Practice Address - Fax:972-316-3322
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-11-10
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXK1092208VP0014X, 208VP0000X, 207L00000X
TX45D2018771291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCJ8159OtherMEDICARE RAILROAD GROUP
TX1982637088OtherGROUP NPI
TX030369501Medicaid
TX720000125OtherMEDICARE RAILROAD INDIVID
TX0045AAMedicare ID - Type Unspecified
TX720000125OtherMEDICARE RAILROAD INDIVID
TXG27476Medicare UPIN
TX00449RMedicare PIN