MEDICARE: DR. SHAHRZAD TABIBI M.D.

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	207V00000X	Obstetrics & Gynecology Physician	MD2018-0662	NM

General Provider Information

NPI Number	:	1861591927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRZAD TABIBI M.D.

Provider Business Mailing Address
First Line	:	2550 SAMARITAN DR STE 201
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1170
Country	:	US
Telephone Number	:	575-386-5548
Fax Number	:	575-652-5319

Provider Business Practice Location Address
First Line	:	2550 SAMARITAN DR STE 201
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1170
Country	:	US
Telephone Number	:	575-386-5548
Fax Number	:	575-652-5319

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/15/2022

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