Provider Demographics
NPI:1164493920
Name:MOHAMED, SHAFFIN ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAFFIN
Middle Name:ALI
Last Name:MOHAMED
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 1:6228 BANDERA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1630
Mailing Address - Country:US
Mailing Address - Phone:210-826-2262
Mailing Address - Fax:210-520-9152
Practice Address - Street 1:6228 BANDERA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1630
Practice Address - Country:US
Practice Address - Phone:210-826-2262
Practice Address - Fax:210-520-9152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7589207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ7589OtherSTATE LICENSE NUMBER
TXG03303Medicare UPIN