Individual
AMMAR TAYARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1220 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3725
(812) 949-3242
Mailing address
PO BOX 950125, LOUISVILLE, KY 40295-0125
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01062587A
IN
207RI0200X
Infectious Disease Physician
Primary
01062587A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000883843
ANTHEM
IN
05
—
200831550
—
IN
05
—
7100331080
—
KY
01
—
P01374600
RAILROAD MEDICARE
IN
Enumeration date
09/03/2006
Last updated
03/27/2015
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