Healthcare Provider Details

I. General information

NPI: 1255536645
Provider Name (Legal Business Name): GULAM HUSSAIN MUSHARAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11019 CULEBRA ROAD STE 155
SAN ANTONIO TX
78253-4653
US

IV. Provider business mailing address

11019 CULEBRA ROAD STE 155
SAN ANTONIO TX
78253-4653
US

V. Phone/Fax

Practice location:
  • Phone: 210-267-5411
  • Fax:
Mailing address:
  • Phone: 210-267-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: