Basic Information
| Provider Information | |||||||||
| NPI: | 1124240890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSABBAGH | ||||||||
| FirstName: | MOURAD | ||||||||
| MiddleName: | MOUSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | PHARR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785771614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563622171 | ||||||||
| FaxNumber: | 9563622420 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E DOVE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785044681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563625433 | ||||||||
| FaxNumber: | 9563622420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 04/06/2018 | ||||||||
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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 | 204F00000X | P4137 | TX | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 207RN0300X | P4137 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 308965802 | 05 | TX | MEDICAID |