Provider Demographics
NPI:1528389145
Name:ANWAR, SHAHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:
Last Name:ANWAR
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 1:1478 STONE POINT DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1478 STONE POINT DR
Practice Address - Street 2:SUITE 290
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2869
Practice Address - Country:US
Practice Address - Phone:916-111-1111
Practice Address - Fax:916-710-8335
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine