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Organization
SHABNAM QASIM MDPA
Active
Organization
SHABNAM QASIM MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSHAN JAGTHAP (CREDENTIALING MANAGER)
(817) 532-3203
Entity
Organization
Contact information
Practice address
4819 RIVER OAKS BLVD, FORT WORTH, TX 76114
(817) 626-9744
(817) 626-9962
Mailing address
4819 RIVER OAKS BLVD, RIVER OAKS, TX 76114-2714
(817) 626-9744
(817) 626-9962
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K9397
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1634057
—
TX
Enumeration date
05/30/2006
Last updated
06/02/2026
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