Healthcare Provider Details

I. General information

NPI: 1174685648
Provider Name (Legal Business Name): MOHAMED SHAFIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 LONE STAR PKWY # 2
SAN ANTONIO TX
78253-2202
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 STE 300
SAN ANTONIO TX
78232-2679
US

V. Phone/Fax

Practice location:
  • Phone: 210-403-7978
  • Fax: 210-680-0206
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-616-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN7390
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN2789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: