Provider Demographics
NPI:1083753677
Name:SHARIF, SUHAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHAIL
Middle Name:
Last Name:SHARIF
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 1:909 9TH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-332-0786
Mailing Address - Fax:817-332-0787
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-332-0786
Practice Address - Fax:817-332-0787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN33032086X0206X
IL036-1136472086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F22617Medicare PIN