Provider Demographics
NPI:1407059595
Name:SHIPCHANDLER, ABEEZAR TAMIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABEEZAR
Middle Name:TAMIM
Last Name:SHIPCHANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4700 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5323
Mailing Address - Country:US
Mailing Address - Phone:469-814-6631
Mailing Address - Fax:469-814-3110
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-6631
Practice Address - Fax:469-814-3110
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN6998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2174419-01Medicaid
TX2174419--02Medicaid
TX2174419--02Medicaid
TXTXB112183Medicare PIN
TXP00942737Medicare PIN