Provider Demographics
NPI:1376595611
Name:SYED, ASIF S (MD)
Entity Type:Individual
Prefix:
First Name:ASIF
Middle Name:S
Last Name:SYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SYED
Other - Middle Name:A
Other - Last Name:SULTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26531
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0531
Mailing Address - Country:US
Mailing Address - Phone:478-550-8383
Mailing Address - Fax:
Practice Address - Street 1:540 E HWY 29
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605
Practice Address - Country:US
Practice Address - Phone:512-355-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8581207R00000X, 207RH0002X, 207RG0300X
GA061665207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA726255782AMedicaid
GA726255782AMedicaid
TX526451YM8AMedicare PIN