Provider Demographics
NPI:1306850227
Name:HANNA-MOUSSA, SHAFIK (MD)
Entity Type:Individual
Prefix:
First Name:SHAFIK
Middle Name:
Last Name:HANNA-MOUSSA
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:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4880
Mailing Address - Fax:903-315-2833
Practice Address - Street 1:703 E MARSHALL AVE STE 5008
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5557
Practice Address - Country:US
Practice Address - Phone:903-315-4880
Practice Address - Fax:903-315-2833
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114818207RC0000X
TXN7098207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX527951YKP5Medicare PIN
ILH73421Medicare UPIN