Individual
DR. MOHAMED BASHAR ABOU SHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6799 GREAT OAKS RD, MEMPHIS, TN 38138-2588
(901) 751-0405
(901) 751-9694
Mailing address
6799 GREAT OAKS RD, MEMPHIS, TN 38138-2588
(901) 751-0405
(901) 751-9694
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
26593
TN
207RI0011X
Interventional Cardiology Physician
Primary
26593
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000015934
TLC
TN
05
—
00116832
—
MS
01
—
02100041401
QUALCHOICE
—
05
—
3094124
—
TN
01
—
4146206
BCBS
TN
01
—
5188055
AETNA
TN
01
—
97426
BCBS
AR
01
—
P00378331
RAIL ROAD MEDICARE
TN
01
—
P00393920
RAIL ROAD MEDICARE
MS
Enumeration date
12/27/2005
Last updated
02/14/2014
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