1588616205 NPI number — DR. SHAHID AZIZ DO

Table of content: DR. SHAHID AZIZ DO (NPI 1588616205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588616205 NPI number — DR. SHAHID AZIZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZIZ
Provider First Name:
SHAHID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588616205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W CANNON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-290-2239
Provider Business Mailing Address Fax Number:
817-885-7811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-885-7888
Provider Business Practice Location Address Fax Number:
817-885-7811
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  H2225 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8S7610 . This is a "BCBS IND. NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00265072 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: H2225 . This is a "TEXAS LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 179767201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179768003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179768002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com