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1700271285

NPI Code Detail

MEDICARE: RAZA MUSHTAQ MD

MEDICARE: RAZA MUSHTAQ MD

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	2085R0202X	Diagnostic Radiology Physician	56994	AZ
2	2085N0700X	Neuroradiology Physician	56994	AZ
3	2085N0700X	Neuroradiology Physician	ME174062	FL
4	2085R0202X	Diagnostic Radiology Physician	ME174062	FL
5	2085N0700X	Neuroradiology Physician	V6653	TX
6	2085R0202X	Diagnostic Radiology Physician	V6653	TX

General Provider Information

NPI Number	:	1700271285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAZA MUSHTAQ MD

Provider Business Mailing Address
First Line	:	PO BOX 44037
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-4037
Country	:	US
Telephone Number	:	602-954-6228
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY STE 310
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1794
Country	:	US
Telephone Number	:	512-654-0300
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	10/18/2025

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Directions to “ RAZA MUSHTAQ MD” Practice Location

Language	Start Address	Practice Location

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