Provider Demographics
NPI:1063414977
Name:SHETAB, RAZEQ ABDUL (MD)
Entity type:Individual
Prefix:DR
First Name:RAZEQ
Middle Name:ABDUL
Last Name:SHETAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:288 W SANTOS AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9337
Mailing Address - Country:US
Mailing Address - Phone:209-599-6018
Mailing Address - Fax:209-599-6018
Practice Address - Street 1:2030 COFFEE RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2413
Practice Address - Country:US
Practice Address - Phone:209-578-1200
Practice Address - Fax:209-578-3757
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA55408207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554081Medicaid
CA00A554081Medicaid
CA00A554081Medicare ID - Type Unspecified