Healthcare Provider Details

I. General information

NPI: 1851399067
Provider Name (Legal Business Name): BASHAR ALASWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 HOSPITAL DRIVE STE 120
BEAUMONT TX
77701-4670
US

IV. Provider business mailing address

PO BOX 2183
STAFFORD TX
77497-2183
US

V. Phone/Fax

Practice location:
  • Phone: 409-813-3883
  • Fax: 409-813-3848
Mailing address:
  • Phone: 409-813-3883
  • Fax: 409-813-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberK0597
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: