Provider Demographics
NPI:1669649596
Name:AHMAD, SHAHAB (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:
Last Name:AHMAD
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 1:2735 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3306
Mailing Address - Country:US
Mailing Address - Phone:361-992-0816
Mailing Address - Fax:
Practice Address - Street 1:2735 AIRLINE RD OFC
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3306
Practice Address - Country:US
Practice Address - Phone:361-992-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252617207R00000X
TXN7046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine