Provider Demographics
NPI:1720296437
Name:TOLAYMAT, SHADI M (MD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:M
Last Name:TOLAYMAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-4244
Practice Address - Street 1:3303 ROGERS RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3688
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-2413
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GN244OtherBCBS
TX189288706Medicaid
TX555597YR99OtherMEDICARE