Basic Information
| Provider Information | |||||||||
| NPI: | 1376685867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFIK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9710 BRIMHALL RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933122779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618296747 | ||||||||
| FaxNumber: | 6618296937 | ||||||||
| Practice Location | |||||||||
| Address1: | 9710 BRIMHALL RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933122779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618296747 | ||||||||
| FaxNumber: | 6618296937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036121484 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | N6650 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 24601 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C145588 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8U3003 | 01 | TX | BCBSTX | OTHER |