Provider Demographics
NPI:1215902184
Name:TABREZ, SHAMS SM (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMS
Middle Name:SM
Last Name:TABREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N PARK AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4102
Mailing Address - Country:US
Mailing Address - Phone:407-797-1179
Mailing Address - Fax:
Practice Address - Street 1:205 N PARK AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4102
Practice Address - Country:US
Practice Address - Phone:407-797-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-318174400000X
FLME98495207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1745Medicaid
NME1745Medicaid