Provider Demographics
NPI:1598846834
Name:IQBAL, SHAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMS
Middle Name:
Last Name:IQBAL
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 1:3600 LIME ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2971
Mailing Address - Country:US
Mailing Address - Phone:951-367-1060
Mailing Address - Fax:951-686-5282
Practice Address - Street 1:3600 LIME ST
Practice Address - Street 2:SUITE 516
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2971
Practice Address - Country:US
Practice Address - Phone:951-367-1060
Practice Address - Fax:951-686-5282
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69076207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24839Medicare UPIN
00A69076Medicare ID - Type Unspecified