Healthcare Provider Details

I. General information

NPI: 1053821710
Provider Name (Legal Business Name): SHAHZAIB ANWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N MOUNT AUBURN RD STE A
CAPE GIRARDEAU MO
63701-2171
US

IV. Provider business mailing address

1417 N MOUNT AUBURN RD STE A
CAPE GIRARDEAU MO
63701-2171
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-2941
  • Fax: 573-803-0815
Mailing address:
  • Phone: 832-287-7247
  • Fax: 573-803-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2017024107
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017024107
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2017024107
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: