=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962690933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KASHIF H. ANSARI M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 08/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610 W BAKER RD STE A
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-837-2288
-----------------------------------------------------
Fax | 281-837-2252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610 W BAKER RD STE A
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-837-2288
-----------------------------------------------------
Fax | 281-837-2252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KASHIF H ANSARI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-837-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | L3557
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------