Provider Demographics
NPI:1245200781
Name:RAFIQ, SHAHID I (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:I
Last Name:RAFIQ
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:PO BOX 5098
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5098
Mailing Address - Country:US
Mailing Address - Phone:409-212-9988
Mailing Address - Fax:409-212-8449
Practice Address - Street 1:87 INTERSTATE 10 N STE 127
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2501
Practice Address - Country:US
Practice Address - Phone:409-860-8181
Practice Address - Fax:409-860-8184
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G55428Medicare UPIN