Provider Demographics
NPI: | 1174666044 |
---|---|
Name: | INSAF, SHAHID S (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SHAHID |
Middle Name: | S |
Last Name: | INSAF |
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: | 3142 W. REMINGTON CT |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65810-2580 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-243-7777 |
Mailing Address - Fax: | 417-243-7778 |
Practice Address - Street 1: | 500 W. MAIN STREET |
Practice Address - Street 2: | SUITE 400 |
Practice Address - City: | BRANSON |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65616-2201 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-243-7777 |
Practice Address - Fax: | 417-243-7778 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-14 |
Last Update Date: | 2009-11-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2005034472 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 207592304 | Medicaid | |
MO | 203025 | Other | MO BLUE SHIELD |
AR | 160533001 | Medicaid | |
AR | 83726 | Other | ARK BLUE SHIELD |
MO | 203025 | Other | MO BLUE SHIELD |
AR | 160533001 | Medicaid |