Basic Information
| Provider Information | |||||||||
| NPI: | 1104096726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELGOUHARI | ||||||||
| FirstName: | HESHAM | ||||||||
| MiddleName: | MOHAMED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5012 S US HIGHWAY 75 STE 220 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166110 | ||||||||
| FaxNumber: | 9034166111 | ||||||||
| Practice Location | |||||||||
| Address1: | 5012 S US HIGHWAY 75 STE 220 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166110 | ||||||||
| FaxNumber: | 9034166111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0008X | 57.011317 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RI0200X | 57.011317 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RT0003X | 57.011317 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | 207RI0008X | 7199 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 256150 | 01 | MIDLAND'S CHOICE | OTHER | 6005870 | 05 | SD | MEDICAID |