Healthcare Provider Details

I. General information

NPI: 1881183960
Provider Name (Legal Business Name): MOHAMED AMER SHAFTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE FL 5
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

875 UNION AVE FL 5
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 857-236-1574
  • Fax:
Mailing address:
  • Phone: 857-236-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3984-18
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: