Basic Information
| Provider Information | |||||||||
| NPI: | 1649761750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUSSEF | ||||||||
| FirstName: | BAHAAELDIN | ||||||||
| MiddleName: | IBRAHIM MAHMOUD | ||||||||
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| Credential: | M.B,CH.B. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70568 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376141707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396210 | ||||||||
| FaxNumber: | 4234398060 | ||||||||
| Practice Location | |||||||||
| Address1: | VA BUILDING 1 CARL A JONES HALL | ||||||||
| Address2: | DOGWOOD AVENUE | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396210 | ||||||||
| FaxNumber: | 4234398060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.