Provider Demographics
NPI:1174606065
Name:SHAH, SYED IRFAN (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:IRFAN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2746 MATLOCK RD
Mailing Address - Street 2:SUITE #150
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2511
Mailing Address - Country:US
Mailing Address - Phone:817-469-1260
Mailing Address - Fax:817-459-4871
Practice Address - Street 1:2746 MATLOCK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2511
Practice Address - Country:US
Practice Address - Phone:817-469-1260
Practice Address - Fax:817-459-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK0192207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029612101Medicaid
TX029612101Medicaid
TX0011ATMedicare ID - Type Unspecified
TX00791DMedicare ID - Type UnspecifiedGRAND PRAIRIE OFFICE