Basic Information
| Provider Information | |||||||||
| NPI: | 1528168788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | ZULFIQAR | ||||||||
| MiddleName: | ALI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 ROYAL GEORGE CIR | ||||||||
| Address2: | |||||||||
| City: | MC QUEENEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781233413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024533799 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1445 HANZ DR | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781302567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024533799 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 47567 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | M3733 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 47567 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | M3733 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 308920305 | 05 | TX | MEDICAID | M3733 | 01 | TX | TEXAS LIC | OTHER | 68080832 | 05 | CO | MEDICAID |