MEDICARE: MR. MEHBOOB S QASSAM M.D.

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	207P00000X	Emergency Medicine Physician	J4972	TX
2	207R00000X	Internal Medicine Physician	J4972	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508821216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MEHBOOB S QASSAM M.D.

Provider Business Mailing Address
First Line	:	6116 LAUREL VALLEY CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 S. FREEWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134
Country	:	US
Telephone Number	:	817-293-9110
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	10/27/2022

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