Basic Information
Provider Information
NPI: 1174577050
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAMAN
FirstName: FAHIM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16620 N US HIGHWAY 281
Address2: SUITE 300
City: SAN ANTONIO
State: TX
PostalCode: 782322327
CountryCode: US
TelephoneNumber: 2106141231
FaxNumber: 2106160704
Practice Location
Address1: 11481 TOEPPERWEIN RD
Address2: SUITE 1202
City: LIVE OAK
State: TX
PostalCode: 782333145
CountryCode: US
TelephoneNumber: 2106558470
FaxNumber: 2109670276
Other Information
ProviderEnumerationDate: 05/22/2006
LastUpdateDate: 12/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XM3435TXY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

ID Information
IDTypeStateIssuerDescription
06083170205TX MEDICAID


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