Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20823 | AL |
N | 111NI0900X | Internist | 20823 | AL |
Y | 207RC0000X | Internist - Cardiovascular Disease | 20823 | AL |
NPI | 1013974179 |
---|---|
Provider Name | Bassam Mushannen |
First Address | Tuscaloosa, AL 35406 |
Second Address | Tuscaloosa, AL 35406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 09/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000075557 | (05) | AL |
51075557 | BCBS (01) | AL |
F66333 | (02) |