Provider Demographics
NPI:1184916660
Name:SHEHRYAR ANJUM, MD, LLC
Entity type:Organization
Organization Name:SHEHRYAR ANJUM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEHRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ANJUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-988-1117
Mailing Address - Street 1:PO BOX 851676
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1676
Mailing Address - Country:US
Mailing Address - Phone:251-988-1117
Mailing Address - Fax:
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-928-2375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51115220OtherBLUE CROSS
AL129682Medicaid
AL102G705344Medicare PIN