Provider Demographics
NPI:1366637332
Name:SHAFIQ, MOIZ MUSTANSHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIZ
Middle Name:MUSTANSHIR
Last Name:SHAFIQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 VALLEY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5012
Mailing Address - Country:US
Mailing Address - Phone:214-924-4073
Mailing Address - Fax:
Practice Address - Street 1:560 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3604
Practice Address - Country:US
Practice Address - Phone:972-972-4252
Practice Address - Fax:877-277-3002
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4527207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133539Medicare PIN