1801047998 NPI number — DR. WAIS TARRAR MD

Table of content: DR. WAIS TARRAR MD (NPI 1801047998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801047998 NPI number — DR. WAIS TARRAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARRAR
Provider First Name:
WAIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801047998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 HOWE AVE STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-678-5280
Provider Business Mailing Address Fax Number:
916-678-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 HOWE AVE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-941-9222
Provider Business Practice Location Address Fax Number:
916-941-0922
Provider Enumeration Date:
10/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  2730 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A117506 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2730 . This is a "TEP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".