=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396757233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAMED ABDULSALAM SHABANEH AL-TAMIMI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 50TH ST # 500
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79412-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-701-5797
-----------------------------------------------------
Fax | 806-701-5798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16770
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79490-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-701-5797
-----------------------------------------------------
Fax | 806-701-5798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M8330
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD00042678
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------