Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | C1-0007984 | DE |
N | 111NI0900X | Internist | C1-0007984 | DE |
N | 207R00000X | Internist | Q2389 | TX |
N | 111NI0900X | Internist | Q2389 | TX |
N | 207RG0300X | Geriatric Medicine | C10007984 | DE |
Y | 207RG0300X | Geriatric Medicine | Q2389 | TX |
NPI | 1053318857 |
---|---|
Provider Name | Emad E Shoukry |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 14/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100503729 | (05) | NV |
342034101 | (05) | TX |
8EV528 | BCBS (01) | TX |
I11466 | (02) | NV |
P01560699 | RAILROAD MEDICARE (01) | TX |