MEDICARE: DR. SHAFFIN ALI MOHAMED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	J7589	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J7589	OTHER	TX	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1164493920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAFFIN ALI MOHAMED M.D.

Provider Business Mailing Address
First Line	:	6228 BANDERA RD
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1630
Country	:	US
Telephone Number	:	210-826-2262
Fax Number	:	210-520-9152

Provider Business Practice Location Address
First Line	:	6228 BANDERA RD
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1630
Country	:	US
Telephone Number	:	210-826-2262
Fax Number	:	210-520-9152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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