Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 38437 | TN |
Y | 207RP1001X | Pulmonary Disease | 38437 | TN |
NPI | 1063407534 |
---|---|
Provider Name | Mohammad A Alsoub |
First Address | Dickson, TN 37055-2856 |
Second Address | Dickson, TN 37055-2080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I295563 | MEDICARE (01) | TN |
1516719 | (05) | TN |
3894698 | (05) | TN |
4138005 | BLUE CROSS BLUE SHIELD TN (01) | TN |
6060612 | BCBS (01) | TN |
F95136 | (02) | |
P00359629 | RAILROAD MEDICARE PIN (01) |