Basic Information
| Provider Information | |||||||||
| NPI: | 1710298153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASHOUR | ||||||||
| FirstName: | SHADI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S RAVENEL ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777290 | ||||||||
| FaxNumber: | 8437777280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E CHEVES ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436696694 | ||||||||
| FaxNumber: | 8436692500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101018765 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | DO37715 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.