Provider Demographics
NPI:1376693986
Name:SHAFI, TARIQ (MD)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2601 THORNTON LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1808
Practice Address - Country:US
Practice Address - Phone:254-724-6622
Practice Address - Fax:254-724-6620
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64330207R00000X, 207RN0300X
TXT9497207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414868100Medicaid
MDKR64S902Medicare PIN
MD414868100Medicaid