=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568462539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED SHAFIQUR REHMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 HIGHWAY 365 STE 210
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77627-6283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-985-6657
-----------------------------------------------------
Fax | 409-982-7805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 HIGHWAY 365 STE 210
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77627-6283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-985-6657
-----------------------------------------------------
Fax | 409-982-7805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | L6598
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------