MEDICARE: DR. AVVI R SHABAT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1668	TX

General Provider Information

NPI Number	:	1164532412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVVI R SHABAT DPM

Provider Business Mailing Address
First Line	:	11100 BRAESRIDGE DR APT 1028
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2153
Country	:	US
Telephone Number	:	713-541-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 W HOLCOMBE BLVD
Second Line	:	SUITE 230
City	:	HOUSTON
State	:	TX
Zip	:	77030-2096
Country	:	US
Telephone Number	:	832-496-7891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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