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General NPI Number Information
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NPI Number | 1841277308
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Entity Type | Individual
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Provider Name | MOHAMED BASHAR ABOU SHALA MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 6799 GREAT OAKS RD
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City | MEMPHIS
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State | TN
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Zip | 38138-2588
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Country | US
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Telephone | 901-751-0405
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Fax | 901-751-9694
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Provider Business Mailing Address
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Address Line | 6799 GREAT OAKS RD
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City | MEMPHIS
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State | TN
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Zip | 38138-2588
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Country | US
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Telephone | 901-751-0405
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Fax | 901-751-9694
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 26593
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License Number State | TN
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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 | 26593
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License Number State | TN
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