Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | N1000 | TX |
NPI | 1043424286 |
---|---|
Provider Name | Dr. Shadi Mourad |
First Address | San Antonio, TX 78232-2327 |
Second Address | Seguin, TX 78155-5719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195928001 | (05) | TX |