Provider Demographics
NPI:1386665545
Name:ALBUSTAMY, ABDULRAHMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDULRAHMAN
Middle Name:
Last Name:ALBUSTAMY
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 1:502 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4660
Mailing Address - Country:US
Mailing Address - Phone:956-292-0100
Mailing Address - Fax:956-383-1906
Practice Address - Street 1:5416 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8326
Practice Address - Country:US
Practice Address - Phone:956-994-3627
Practice Address - Fax:956-687-4944
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6525207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101763401Medicaid
TXF80740Medicare UPIN
TX8516K5Medicare ID - Type Unspecified