Provider Demographics
NPI:1942793708
Name:BUKSH, SHAZAD ASHRAF (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAZAD
Middle Name:ASHRAF
Last Name:BUKSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 TIMBERLINE LN SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9564
Mailing Address - Country:US
Mailing Address - Phone:833-469-2692
Mailing Address - Fax:833-342-1173
Practice Address - Street 1:1797 TIMBERLINE LN SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9564
Practice Address - Country:US
Practice Address - Phone:833-462-2692
Practice Address - Fax:833-342-1173
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO61157008213ES0103X
IDP-262213ES0103X
ORDP197850213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500791205Medicaid
R227870OtherMEDICARE PTAN
P02649430OtherRAILROAD MEDICARE