Basic Information
| Provider Information | |||||||||
| NPI: | 1659356335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHBOOB | ||||||||
| FirstName: | RASHID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397280 | ||||||||
| FaxNumber: | 4234397314 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 N STATE OF FRANKLIN RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397280 | ||||||||
| FaxNumber: | 4234397314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39877 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 0101246754 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 208M00000X | 40100 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RE0101X | 40100 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 3332424 | 05 | TN | MEDICAID | 4122043 | 01 | TN | BCBST | OTHER | P00334007 | 01 | TN | RR MEDICARE | OTHER | TN0117 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |