Provider Demographics
NPI:1659356335
Name:MAHBOOB, RASHID (MD)
Entity Type:Individual
Prefix:
First Name:RASHID
Middle Name:
Last Name:MAHBOOB
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:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-439-7280
Mailing Address - Fax:423-439-7314
Practice Address - Street 1:325 N STATE OF FRANKLIN RD FL 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:423-439-7314
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39877207R00000X
VA0101246754207RE0101X
TN40100208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3332424Medicaid
TN4122043OtherBCBST
TNP00334007OtherRR MEDICARE
TNTN0117OtherJOHN DEERE HEALTHCARE
TN4122043OtherBCBST
TN103I114379Medicare PIN
TNP00334007OtherRR MEDICARE