1114989746 NPI number — NAYER B EL-ASHRAM MD

Table of content: NAYER B EL-ASHRAM MD (NPI 1114989746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114989746 NPI number — NAYER B EL-ASHRAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-ASHRAM
Provider First Name:
NAYER
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114989746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HOSPITAL DR STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110-2489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-641-3815
Provider Business Mailing Address Fax Number:
903-641-3863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 S FM 51 STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76234-3864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-627-1435
Provider Business Practice Location Address Fax Number:
940-627-1453
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  H9071 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 034345104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034345105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00K19Y . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 034345103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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