Provider Demographics
NPI:1225127392
Name:AZHAR, RUKSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUKSHAN
Middle Name:
Last Name:AZHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 COASTAL OAK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-6443
Mailing Address - Country:US
Mailing Address - Phone:281-488-8771
Mailing Address - Fax:
Practice Address - Street 1:2802 GARTH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-428-7997
Practice Address - Fax:281-428-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ78942084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113400902Medicaid
TX0027AYMedicare ID - Type Unspecified
TXG16488Medicare UPIN