Basic Information
| Provider Information | |||||||||
| NPI: | 1053821710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANWAR | ||||||||
| FirstName: | SHAHZAIB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 N MOUNT AUBURN RD STE A | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322877247 | ||||||||
| FaxNumber: | 5738030815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 N MOUNT AUBURN RD STE A | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738032941 | ||||||||
| FaxNumber: | 5738030815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2017 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 2017024107 | MO | N | Allopathic & Osteopathic Physicians | General Practice | 363A00000X | 2017024107 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 2017024107 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.