Basic Information
| Provider Information | |||||||||
| NPI: | 1528324605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUAIB | ||||||||
| FirstName: | STEFAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | PHARR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785771614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563622171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 909 BUSINESS PARK DR | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785726052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563622171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | R1646 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207Y00000X | R1646 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 367742901 | 05 | TX | MEDICAID |