Provider Demographics
NPI:1588616205
Name:AZIZ, SHAHID (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-290-2239
Mailing Address - Fax:817-885-7811
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2228
Practice Address - Country:US
Practice Address - Phone:817-885-7888
Practice Address - Fax:817-885-7811
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2225207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7610OtherBCBS IND. NUMBER
P00265072OtherMEDICARE RR
TXH2225OtherTEXAS LICENSE NUMBER
TX179767201Medicaid
TX179768003Medicaid
TX179768002Medicaid
TXH2225OtherTEXAS LICENSE NUMBER
TX8S7610OtherBCBS IND. NUMBER
203057395OtherTAX ID NUMBER
P00265072OtherMEDICARE RR
TX8K7260Medicare PIN