Provider Demographics
NPI:1841245537
Name:ALSHAIAL, ZOHAYR (MD)
Entity Type:Individual
Prefix:DR
First Name:ZOHAYR
Middle Name:
Last Name:ALSHAIAL
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 1:420 ROYAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3951
Mailing Address - Country:US
Mailing Address - Phone:636-675-6876
Mailing Address - Fax:
Practice Address - Street 1:1402 S GRAND BLVD RM M238
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-977-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO928764475Medicare ID - Type UnspecifiedMISSOURI MEDICARE
MO207327511Medicare ID - Type UnspecifiedMISSOURI MEDICAID
I28083Medicare UPIN