Provider Demographics
NPI:1932113891
Name:ABSOOD, SAFWAT MAHER (MD)
Entity Type:Individual
Prefix:
First Name:SAFWAT
Middle Name:MAHER
Last Name:ABSOOD
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:PO BOX 4848
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4848
Mailing Address - Country:US
Mailing Address - Phone:209-576-1621
Mailing Address - Fax:209-576-2208
Practice Address - Street 1:500 COFFEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4926
Practice Address - Country:US
Practice Address - Phone:209-576-1621
Practice Address - Fax:209-576-2208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30093207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A300930Medicaid
A25963Medicare UPIN
CA00A300930Medicaid