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General NPI Number Information
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NPI Number | 1700271285
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Entity Type | Individual
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Provider Name | RAZA MUSHTAQ MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 200 MEDICAL PKWY STE 310
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City | LAKEWAY
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State | TX
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Zip | 78738-1794
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Country | US
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Telephone | 512-654-0300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44037
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City | PHOENIX
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State | AZ
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Zip | 85064-4037
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Country | US
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Telephone | 602-954-6228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 56994
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 56994
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME174062
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME174062
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | V6653
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | V6653
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License Number State | TX
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