Provider Demographics
NPI:1649280777
Name:AHMAD, TANVIR (MD)
Entity type:Individual
Prefix:DR
First Name:TANVIR
Middle Name:
Last Name:AHMAD
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 1:615 S HIGHWAY 78
Mailing Address - Street 2:STE 100
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4099
Mailing Address - Country:US
Mailing Address - Phone:509-594-6119
Mailing Address - Fax:
Practice Address - Street 1:2501 ELK TRL
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-6022
Practice Address - Country:US
Practice Address - Phone:509-594-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8411944Medicaid
WA8411944Medicaid
WA8802140Medicare ID - Type Unspecified