MEDICARE: SHAFA MEDICAL SERVICES, PLLC

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	208VP0000X	Pain Medicine Physician	N4048	TX

General Provider Information

NPI Number	:	1679838940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAFA MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	4821 CYPRESS PT
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-6825
Country	:	US
Telephone Number	:	940-612-8760
Fax Number	:	940-665-0209

Provider Business Practice Location Address
First Line	:	2024 W HIGHWAY 82
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2051
Country	:	US
Telephone Number	:	940-612-8760
Fax Number	:	940-665-0209

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RAMIN ROUFEH
Credential	:	MD
Telephone Number	:	940-612-8760

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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