Healthcare Provider Details

I. General information

NPI: 1598846834
Provider Name (Legal Business Name): SHAMS IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LIME ST SUITE 516
RIVERSIDE CA
92501-2971
US

IV. Provider business mailing address

3600 LIME ST SUITE 516
RIVERSIDE CA
92501-2971
US

V. Phone/Fax

Practice location:
  • Phone: 951-367-1060
  • Fax: 951-686-5282
Mailing address:
  • Phone: 951-367-1060
  • Fax: 951-686-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA69076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: