Provider Demographics
NPI:1295793958
Name:SHAFI, MUDASSIR AHMED (MD)
Entity type:Individual
Prefix:
First Name:MUDASSIR
Middle Name:AHMED
Last Name:SHAFI
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 1:800 PEAKWOOD DR STE 5E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2903
Mailing Address - Country:US
Mailing Address - Phone:281-440-5158
Mailing Address - Fax:
Practice Address - Street 1:800 PEAKWOOD DR STE 5E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-440-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00076862085R0202X
TXL31192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1466781-09Medicaid
DE003826D14Medicare PIN
H49573Medicare UPIN
DE017639O73Medicare PIN
DE003388G66Medicare PIN
DE017634P97Medicare PIN
DE017637B93Medicare PIN