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General NPI Number Information
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NPI Number | 1366567471
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Entity Type | Individual
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Provider Name | MOHAMMED HOSAM ALDIN BACCORA MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 1701 3RD ST SE STE 300
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City | PUYALLUP
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State | WA
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Zip | 98372-4511
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Country | US
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Telephone | 253-697-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 3RD ST SE STE 300
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City | PUYALLUP
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State | WA
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Zip | 98372-4511
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Country | US
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Telephone | 253-697-4740
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Fax |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00049133
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00049133
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License Number State | WA
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