1952380107 NPI number — DR. SHABBIR H SAFDAR M.D

Table of content: DR. SHABBIR H SAFDAR M.D (NPI 1952380107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952380107 NPI number — DR. SHABBIR H SAFDAR M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFDAR
Provider First Name:
SHABBIR
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1952380107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4921 PARKVIEW PL
Provider Second Line Business Mailing Address:
SUITE 14C
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-290-7555
Provider Business Mailing Address Fax Number:
314-290-7550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4921 PARKVIEW PL
Provider Second Line Business Practice Location Address:
SUITE 14C
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-290-7555
Provider Business Practice Location Address Fax Number:
314-290-7550
Provider Enumeration Date:
01/15/2006

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: 207RH0003X , with the licence number:  R3981 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 336010862 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 304010 . This is a "MEDICARE IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036043159 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105905 . This is a "IL WORKER'S COMP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 123513 . This is a "WORKMEN'S COMP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 201262128 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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