Individual
TALIA E HAIDERZAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
(573) 686-1029
Mailing address
PO BOX 280, POPLAR BLUFF, MO 63902-0280
(573) 686-1200
(573) 686-1029
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M103571
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11060304
CAQH
—
05
—
146412001
—
AR
05
—
208103432
—
MO
01
—
255217
VALUE OPTIONS
—
Enumeration date
09/25/2006
Last updated
01/21/2009
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