Provider Demographics
NPI:1356801138
Name:TARIQ, SHAFAQ (MD)
Entity type:Individual
Prefix:MS
First Name:SHAFAQ
Middle Name:
Last Name:TARIQ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MATLOCK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6889
Mailing Address - Country:US
Mailing Address - Phone:817-539-9091
Mailing Address - Fax:817-539-9553
Practice Address - Street 1:350 MATLOCK RD STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6889
Practice Address - Country:US
Practice Address - Phone:817-539-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9673207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine