Provider Demographics
NPI:1093155483
Name:AHMAD, MUDASSAR RAEES (MB,BS)
Entity type:Individual
Prefix:DR
First Name:MUDASSAR
Middle Name:RAEES
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5309
Mailing Address - Country:US
Mailing Address - Phone:253-363-8700
Mailing Address - Fax:253-272-0419
Practice Address - Street 1:1708 YAKIMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5309
Practice Address - Country:US
Practice Address - Phone:253-363-8700
Practice Address - Fax:253-272-0419
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61659187207RS0012X, 207RP1001X
WI75089208M00000X
PAMD458440208M00000X
MN76305207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist