Provider Demographics
NPI:1134165988
Name:RAFIQ, SHAHIDA (MD)
Entity type:Individual
Prefix:
First Name:SHAHIDA
Middle Name:
Last Name:RAFIQ
Suffix:
Gender:F
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 830050
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-0050
Mailing Address - Country:US
Mailing Address - Phone:214-256-5759
Mailing Address - Fax:214-432-9011
Practice Address - Street 1:875 COTSWOLDS CT
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5062
Practice Address - Country:US
Practice Address - Phone:214-256-5759
Practice Address - Fax:214-432-9011
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2189Medicare PIN
TXP00079903Medicare PIN
G62821Medicare UPIN