Provider Demographics
NPI:1417932948
Name:AL-CHALABI, MUSTAFA T (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:T
Last Name:AL-CHALABI
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 201606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1606
Mailing Address - Country:US
Mailing Address - Phone:972-758-3523
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-758-3523
Practice Address - Fax:972-599-9604
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1459207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175732001Medicaid
TX175732002Medicaid
TXP00373924OtherRAILROAD
TX8W0187OtherBCBS
NM27939243Medicaid
TX8S2683OtherBCBS
TX175732003Medicaid
TX8S5974OtherBCBS
TXP00273729OtherRAILROAD
NM27939243Medicaid
TX175732003Medicaid
TX8S2683OtherBCBS
TX175732001Medicaid