Individual
MR. TAHIR QAYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12700 SOUTHFORK ROAD, SUITE 220, SAINT LOUIS, MO 63128-2106
(314) 543-5942
(314) 543-5947
Mailing address
9735 LANDMARK PARKWAY DR, STE 220, SAINT LOUIS, MO 63127-1646
(314) 543-5942
(314) 543-5947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11011
MO
208D00000X
General Practice Physician
106241
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208093419
—
MO
Enumeration date
12/12/2006
Last updated
03/14/2017
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