Provider Demographics
NPI:1659721074
Name:ANWAR, TAHA
Entity Type:Individual
Prefix:
First Name:TAHA
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:MC404
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-884-2000
Mailing Address - Fax:
Practice Address - Street 1:3319 SPRING ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2125
Practice Address - Country:US
Practice Address - Phone:563-359-1641
Practice Address - Fax:563-359-4634
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016019975OtherMISSOURI BOARD OF HEALING ARTS