Provider Demographics
NPI:1750460192
Name:QADIR, HAMMAD
Entity Type:Individual
Prefix:
First Name:HAMMAD
Middle Name:
Last Name:QADIR
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 1:2008 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1364
Mailing Address - Country:US
Mailing Address - Phone:541-217-8790
Mailing Address - Fax:541-808-2411
Practice Address - Street 1:1860 VIRGINIA AVE STE 8
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2355
Practice Address - Country:US
Practice Address - Phone:541-808-2412
Practice Address - Fax:541-808-2411
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD197421207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500719505Medicaid
AR154562001Medicaid
MO209178904Medicaid
AR154562001Medicaid