Provider Demographics
NPI:1417054719
Name:CHAKER, MOHAMMED BASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:BASEM
Last Name:CHAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12001 SOUTH FWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7208
Mailing Address - Country:US
Mailing Address - Phone:817-568-0500
Mailing Address - Fax:817-568-0501
Practice Address - Street 1:12001 SOUTH FWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7208
Practice Address - Country:US
Practice Address - Phone:817-568-0500
Practice Address - Fax:817-568-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9018207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113349801Medicaid
TX113349801Medicaid
TXE60667Medicare UPIN