Provider Demographics
NPI:1568623155
Name:SHABB, BASEM RAMZI (MD)
Entity Type:Individual
Prefix:
First Name:BASEM
Middle Name:RAMZI
Last Name:SHABB
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 1:1105 W FRANK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-631-6777
Mailing Address - Fax:936-631-6778
Practice Address - Street 1:1105 W FRANK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-631-6777
Practice Address - Fax:936-631-6778
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3172208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3172OtherTEXAS MEDICAL BOARD