Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | L1258 | TX |
Y | 2084N0402X | Child Neurologist | L1258 | TX |
NPI | 1023016458 |
---|---|
Provider Name | Dr. Mohamad S Al-Rifai |
First Address | Sherman, TX 75092-7378 |
Second Address | Sherman, TX 75092-7378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2005 |
Last Update Date | 06/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00U28Q | (02) | TX |
030289503 | (05) | TX |
100058120A | (05) | OK |
8151K2 | BLUE CROSS (01) | TX |
G45781 | (02) | TX |