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General NPI Number Information
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NPI Number | 1134459472
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Entity Type | Individual
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Provider Name | MOHANNAD BASEM BISHARAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 3023 PERRYTON PKWY SUITE 101
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City | PAMPA
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State | TX
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Zip | 79065-2821
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Country | US
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Telephone | 806-663-5523
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Fax | 806-669-1491
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Provider Business Mailing Address
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Address Line | 3023 PERRYTON PKWY SUITE 101
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City | PAMPA
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State | TX
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Zip | 79065-2821
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Country | US
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Telephone | 806-663-5523
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Fax | 806-669-1491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08532200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | Q3484
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License Number State | TX
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