Individual
ERIC MARK ALCOULOUMRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HOAG DR, ECU DEPT., NEWPORT BEACH, CA 92663-4162
(949) 637-9158
(405) 751-3183
Mailing address
PO BOX 720300, OKLAHOMA CITY, OK 73172-0300
(800) 749-4560
(405) 751-3183
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G44915
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G443150
BLUE SHIELD
CA
05
—
00G449150
—
CA
05
—
00G449150670
—
CA
01
—
P00242778
RR MEDICARE
CA
01
—
V/17054
CHAMPUS
CA
Enumeration date
04/11/2006
Last updated
06/21/2024
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