Individual
BASSAM MUSHANNEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1060 FAIRFAX PARK, STE B, TUSCALOOSA, AL 35406
(205) 758-6471
(205) 758-6472
Mailing address
2760 LAKE CREST DR, TUSCALOOSA, AL 35406
(205) 752-9117
(205) 758-6472
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20823
AL
207RC0000X
Cardiovascular Disease Physician
Primary
20823
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000075557
—
AL
01
—
51075557
BCBS
AL
Enumeration date
05/01/2006
Last updated
06/09/2008
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