Healthcare Provider Details

I. General information

NPI: 1720442650
Provider Name (Legal Business Name): AHMED ALSHABAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOSPITAL DR STE 100
SEDRO WOOLLEY WA
98284-9315
US

IV. Provider business mailing address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-8800
  • Fax: 360-714-2522
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberT4106
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61460436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: