Provider Demographics
NPI:1750343760
Name:KHALID, SHAFI M (MD)
Entity type:Individual
Prefix:
First Name:SHAFI
Middle Name:M
Last Name:KHALID
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 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-485-7246
Mailing Address - Fax:858-485-8676
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-485-7246
Practice Address - Fax:858-485-8676
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51093207RG0300X, 2084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144299100OtherFIRSTCARE COMMERCIAL
TX037623806Medicaid
CA1750343760Medicaid
NM202000179Medicaid
TX037623805Medicaid
NM202000179OtherPRESBYTERIAN COMMERCIAL
CA1740228469Medicaid
OK200060420AMedicaid
TXJ0105431OtherDPS
TX144299101Medicaid
TX450686CG62103OtherSECTION 1011
NM49371312Medicaid
TX87927ZOtherHMO BLUE
TX8M0237OtherBC/BS
TXP00226076Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX144299101Medicaid
TXG62103Medicare UPIN