MEDICARE: KHAMIS A SHALABI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	U3014	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1124505300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAMIS A SHALABI MD

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-606-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 E MARSHALL AVE STE 1001
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5500
Country	:	US
Telephone Number	:	903-753-7291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2018
Last Update Date	:	06/02/2026

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Directions to “ KHAMIS A SHALABI MD” Practice Location

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