Provider Demographics
NPI:1811077738
Name:SHAH, SYED RIZWAN (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:RIZWAN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 MATLOCK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2531
Mailing Address - Country:US
Mailing Address - Phone:817-461-8199
Mailing Address - Fax:817-461-7565
Practice Address - Street 1:2746 MATLOCK RD
Practice Address - Street 2:STE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2531
Practice Address - Country:US
Practice Address - Phone:817-461-8199
Practice Address - Fax:817-461-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0888BWMedicare PIN
TXF94677Medicare UPIN