Basic Information
Provider Information
NPI: 1497095707
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANWAR
FirstName: TAHIR
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2145 5TH AVE
Address2:  
City: OROVILLE
State: CA
PostalCode: 959655870
CountryCode: US
TelephoneNumber: 5305345394
FaxNumber: 5305343820
Practice Location
Address1: 2145 5TH AVE
Address2:  
City: OROVILLE
State: CA
PostalCode: 959655870
CountryCode: US
TelephoneNumber: 5305345394
FaxNumber: 5305343820
Other Information
ProviderEnumerationDate: 02/22/2013
LastUpdateDate: 06/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X282278NYN Allopathic & Osteopathic PhysiciansFamily Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000X15147CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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