Provider Demographics
NPI:1255536645
Name:MUSHARAF, GULAM HUSSAIN (MD)
Entity type:Individual
Prefix:DR
First Name:GULAM
Middle Name:HUSSAIN
Last Name:MUSHARAF
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 1:11019 CULEBRA ROAD
Mailing Address - Street 2:STE 155
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4653
Mailing Address - Country:US
Mailing Address - Phone:210-267-5411
Mailing Address - Fax:
Practice Address - Street 1:11019 CULEBRA ROAD
Practice Address - Street 2:STE 155
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4653
Practice Address - Country:US
Practice Address - Phone:210-267-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186576802OtherCSHCN
TX186576801Medicaid
TX8L11072Medicare PIN
TX186576801Medicaid