MEDICARE: MOHAMMAD A ALSOUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	38437	TN
2	207RP1001X	Pulmonary Disease Physician	38437	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	103I295563	OTHER	TN	MEDICARE
5	P00359629	OTHER		RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4138005	OTHER	TN	BLUE CROSS BLUE SHIELD TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6060612	OTHER	TN	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063407534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD A ALSOUB MD

Provider Business Mailing Address
First Line	:	127 CRESTVIEW PARK DR STE 209
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2856
Country	:	US
Telephone Number	:	615-446-5121
Fax Number	:	615-446-1359

Provider Business Practice Location Address
First Line	:	111 HIGHWAY 70 E STE 102
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2080
Country	:	US
Telephone Number	:	615-375-1531
Fax Number	:	615-375-1526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	04/16/2025

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Directions to “ MOHAMMAD A ALSOUB MD” Practice Location

Language	Start Address	Practice Location

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