Provider Demographics
NPI:1043473820
Name:ISLAM, RAFIUL SAMEER (MD)
Entity Type:Individual
Prefix:
First Name:RAFIUL
Middle Name:SAMEER
Last Name:ISLAM
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 1:4505 82ND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3219
Mailing Address - Country:US
Mailing Address - Phone:806-696-4440
Mailing Address - Fax:806-696-4441
Practice Address - Street 1:4505 82ND ST STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3219
Practice Address - Country:US
Practice Address - Phone:806-696-4440
Practice Address - Fax:806-696-4441
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7811207RG0100X
AZ442244207RG0100X
TXBP1-0032627390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ670489Medicaid
AZ670489Medicaid