Provider Demographics
NPI:1316102544
Name:TAHIR, OMAR ZAHOOR (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ZAHOOR
Last Name:TAHIR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:71780 SAN JACINTO DR BLDG I
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-568-3461
Mailing Address - Fax:760-423-6273
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-596-3363
Practice Address - Fax:760-596-3366
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC1803262086S0129X
MO20190412692086S0129X
IL0361368882086S0129X
AZ639592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC180326OtherSTATE LICENSE