Healthcare Provider Details

I. General information

NPI: 1780116061
Provider Name (Legal Business Name): BASSEM ARAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALTIMORE
SAN ANTONIO TX
78215-1919
US

IV. Provider business mailing address

1501 KINGS HWY INTERNAL MEDICINE
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0743
  • Fax:
Mailing address:
  • Phone: 318-626-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberT2552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: