Provider Demographics
NPI:1588851232
Name:BASHIR, MAMOUN E (MD)
Entity Type:Individual
Prefix:
First Name:MAMOUN
Middle Name:E
Last Name:BASHIR
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 1:3302 W GOLF COURSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5110
Mailing Address - Country:US
Mailing Address - Phone:432-522-2304
Mailing Address - Fax:432-522-2307
Practice Address - Street 1:3302 W GOLF COURSE RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5110
Practice Address - Country:US
Practice Address - Phone:432-522-2304
Practice Address - Fax:432-522-2307
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9147207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1588851232Medicaid
TX194080104Medicaid
TX194080107Medicaid