Healthcare Provider Details

I. General information

NPI: 1558542068
Provider Name (Legal Business Name): SHABREZ TARIQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 GREENBRIAR DR STE 208
HOUSTON TX
77098-5266
US

IV. Provider business mailing address

4101 GREENBRIAR DR STE 208
HOUSTON TX
77098-5266
US

V. Phone/Fax

Practice location:
  • Phone: 832-777-7246
  • Fax: 832-706-7777
Mailing address:
  • Phone: 832-777-7246
  • Fax: 832-706-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN9968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: