Provider Demographics
NPI:1952615395
Name:TAHIR YAQUB MD INC
Entity type:Organization
Organization Name:TAHIR YAQUB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-388-1371
Mailing Address - Street 1:336 E BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2727
Mailing Address - Country:US
Mailing Address - Phone:209-489-0809
Mailing Address - Fax:
Practice Address - Street 1:1775 3RD STREET
Practice Address - Street 2:OPTIONAL
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-3608
Practice Address - Country:US
Practice Address - Phone:209-358-5611
Practice Address - Fax:209-358-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96088261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77315ZOtherMEDI-CAL CALIFORNIA
CAPP00376233OtherRAILROAD MEDICARE
CAI65862Medicare UPIN
CA00A960880Medicare PIN