Provider Demographics
NPI:1699825661
Name:SHABBIR HUSAIN JAMALI MD PA
Entity Type:Organization
Organization Name:SHABBIR HUSAIN JAMALI MD PA
Other - Org Name:GASTROENTEROLOGY DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-357-1977
Mailing Address - Street 1:421 SCHOOL ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4589
Mailing Address - Country:US
Mailing Address - Phone:281-357-1977
Mailing Address - Fax:281-357-1057
Practice Address - Street 1:421 SCHOOL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4589
Practice Address - Country:US
Practice Address - Phone:281-357-1977
Practice Address - Fax:281-357-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3260207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1799397Medicaid
TX1799397Medicaid
TX00822XMedicare PIN