Provider Demographics
NPI:1659302438
Name:MAHMOOD, SHEHRYAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHEHRYAR
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-0234
Mailing Address - Country:US
Mailing Address - Phone:760-992-5470
Mailing Address - Fax:760-992-5471
Practice Address - Street 1:35400 BOB HOPE DR STE 209
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1774
Practice Address - Country:US
Practice Address - Phone:760-202-0686
Practice Address - Fax:760-770-4563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50488207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C504880Medicaid
CA00C504880Medicare PIN
E70492Medicare UPIN