Provider Demographics
NPI:1164532412
Name:SHABAT, AVVI R (DPM)
Entity Type:Individual
Prefix:DR
First Name:AVVI
Middle Name:R
Last Name:SHABAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 BRAESRIDGE DR APT 1028
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2153
Mailing Address - Country:US
Mailing Address - Phone:713-541-4312
Mailing Address - Fax:
Practice Address - Street 1:2201 W HOLCOMBE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2096
Practice Address - Country:US
Practice Address - Phone:832-496-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1668213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609943Medicare UPIN