Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | Q7829 | TX |
Y | 111NI0900X | Internist | Q7829 | TX |
N | 207RN0300X | Nephrologist | Q7829 | TX |
NPI | 1003195256 |
---|---|
Provider Name | Mustafa Aly |
First Address | Brentwood, TN 37027-5339 |
Second Address | Lubbock, TX 79410-1203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 17/03/2018 |