Organization
M. TAHIR QAYYUM, MD, PMC
Active
Other names
Family Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. M. TAHIR QAYYUM M.D. (OWNER)
(318) 283-2200
Entity
Organization
Contact information
Practice address
540 DURHAM STREET, BASTROP, LA 71220
(318) 283-2200
(318) 283-1200
Mailing address
540 DURHAM ST, BASTROP, LA 71220-5013
(318) 283-2200
(318) 283-1200
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
10850R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447111
—
LA
Enumeration date
05/15/2008
Last updated
10/13/2025
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