Provider Demographics
NPI:1053474361
Name:MUSA, M. BAKRI (MD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:BAKRI
Last Name:MUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH ST
Mailing Address - Street 2:SUITE S
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6014
Mailing Address - Country:US
Mailing Address - Phone:408-842-1511
Mailing Address - Fax:408-842-5366
Practice Address - Street 1:700 W 6TH ST
Practice Address - Street 2:SUITE S
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6014
Practice Address - Country:US
Practice Address - Phone:408-842-1511
Practice Address - Fax:408-842-5366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G434010Medicaid
CACALIFORNIA LICENCEOtherG43401
CA00G434010Medicaid
CACALIFORNIA LICENCEOtherG43401