Provider Demographics
NPI:1487997540
Name:TAHA, RAMI (MD)
Entity type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:TAHA
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 1:4125 TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7902
Mailing Address - Country:US
Mailing Address - Phone:908-821-5929
Mailing Address - Fax:
Practice Address - Street 1:3839 MCKINNEY AVENUE
Practice Address - Street 2:SUITE 155-2416
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204
Practice Address - Country:US
Practice Address - Phone:469-626-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR0145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program