Provider Demographics
NPI:1700855418
Name:BUHARI, SHIRAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRAZ
Middle Name:
Last Name:BUHARI
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 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-477-4421
Mailing Address - Fax:209-477-7721
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-477-4421
Practice Address - Fax:209-477-7721
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27767ZMedicare PIN
CAY02271Medicare UPIN
CAH98314Medicare UPIN