Individual
DR. QAISAR QAYYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13974 S BROADWAY, EDMOND, OK 73034-8144
(405) 562-8715
(405) 562-8717
Mailing address
PO BOX 31195, EDMOND, OK 73003-0020
(405) 562-8715
(405) 562-8717
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21912
OK
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
21912
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063090A
—
OK
Enumeration date
06/01/2006
Last updated
06/22/2020
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