=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598846834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMS IQBAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 04/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 LIME ST SUITE 516
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92501-2971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-367-1060
-----------------------------------------------------
Fax | 951-686-5282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 LIME ST SUITE 516
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92501-2971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-367-1060
-----------------------------------------------------
Fax | 951-686-5282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number | A69076
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------