Provider Demographics
NPI:1912919952
Name:AFRIDI, SHAH NAWAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAH
Middle Name:NAWAZ
Last Name:AFRIDI
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 1:2705 HOSPITAL DR
Mailing Address - Street 2:STE101
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5748
Mailing Address - Country:US
Mailing Address - Phone:361-574-1720
Mailing Address - Fax:361-574-1721
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:STE101
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5748
Practice Address - Country:US
Practice Address - Phone:361-574-1720
Practice Address - Fax:361-574-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD30351301Medicaid
TXD30351301Medicaid
TX8F23405Medicare PIN