Healthcare Provider Details

I. General information

NPI: 1922523042
Provider Name (Legal Business Name): BNA MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BRAND RD STE 700
MURPHY TX
75094-3734
US

IV. Provider business mailing address

3515 ARISTA BLVD APT 27
TEXARKANA TX
75503-1196
US

V. Phone/Fax

Practice location:
  • Phone: 469-445-2445
  • Fax:
Mailing address:
  • Phone: 973-573-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberP0534
License Number StateTX

VIII. Authorized Official

Name: BASHAR NIMAN ALSHAREEF
Title or Position: OWNER
Credential: MD
Phone: 973-573-1774