Provider Demographics
NPI:1801047998
Name:TARRAR, WAIS (MD)
Entity type:Individual
Prefix:DR
First Name:WAIS
Middle Name:
Last Name:TARRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 HOWE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5513
Mailing Address - Country:US
Mailing Address - Phone:916-678-5280
Mailing Address - Fax:916-678-5289
Practice Address - Street 1:391 HOWE AVE STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5513
Practice Address - Country:US
Practice Address - Phone:916-941-9222
Practice Address - Fax:916-941-0922
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2730390200000X
CAA117506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2730OtherTEP