Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | R1646 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | R1646 | TX |
NPI | 1528324605 |
---|---|
Provider Name | Stefan Shuaib |
First Address | Pharr, TX 78577-1614 |
Second Address | Mission, TX 78572-6052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367742901 | (05) | TX |