Individual
MOHAMED AMER SHAFTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
875 UNION AVE FL 5, MEMPHIS, TN 38103-3513
(857) 236-1574
Mailing address
875 UNION AVE FL 5, MEMPHIS, TN 38103-3513
(857) 236-1574
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
3984-18
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
STAS00461895
BCBS TN
TN
01
—
STAS00461895
BLUE CROSS BLUE SHIELD OF TENNESSEE
—
Enumeration date
05/04/2018
Last updated
05/04/2018
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