Provider Demographics
NPI:1255651477
Name:AHMAD, SHOAIB (MD)
Entity Type:Individual
Prefix:
First Name:SHOAIB
Middle Name:
Last Name:AHMAD
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 1:608 NW 9TH ST STE 3110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1049
Mailing Address - Country:US
Mailing Address - Phone:405-772-4400
Mailing Address - Fax:405-772-4402
Practice Address - Street 1:608 NW 9TH ST STE 3110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1049
Practice Address - Country:US
Practice Address - Phone:405-772-4400
Practice Address - Fax:405-772-4402
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27807207R00000X, 207RP1001X
TXR0822207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200314890AMedicaid