Provider Demographics
NPI:1174685648
Name:SHAFIU, MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:SHAFIU
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 1:16620 N US HIGHWAY 281 STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-614-1231
Mailing Address - Fax:210-616-0704
Practice Address - Street 1:5620 LONE STAR PKWY # 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2202
Practice Address - Country:US
Practice Address - Phone:210-403-7978
Practice Address - Fax:210-680-0206
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN7390207R00000X
TXN2789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206371101Medicaid
TX206371101Medicaid