MEDICARE: SHOBASSY G.I.,P.A.

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	207RG0100X	Gastroenterology Physician	E7278	TX

General Provider Information

NPI Number	:	1649683319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOBASSY G.I.,P.A.

Provider Business Mailing Address
First Line	:	2400 HWY 265 STE 203
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627
Country	:	US
Telephone Number	:	409-983-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 HIGHWAY 365 STE 203
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6250
Country	:	US
Telephone Number	:	409-727-3004
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEZAR A. SHOBASSY,
Credential	:	M.D.
Telephone Number	:	409-983-3221

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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