Healthcare Provider Details

I. General information

NPI: 1043424286
Provider Name (Legal Business Name): SHADI MOURAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E COURT ST
SEGUIN TX
78155-5719
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 SUITE 300
SAN ANTONIO TX
78232-2327
US

V. Phone/Fax

Practice location:
  • Phone: 210-655-8470
  • Fax: 210-967-0276
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-616-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN1000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: