Provider Demographics
NPI:1922143544
Name:M. BASEM CHAKER, M.D. P.A.
Entity Type:Organization
Organization Name:M. BASEM CHAKER, M.D. P.A.
Other - Org Name:DERMATOLOGY SOUTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-568-0500
Mailing Address - Street 1:12001 SOUTH FREEWAY
Mailing Address - Street 2:#205
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-568-0500
Mailing Address - Fax:817-568-0501
Practice Address - Street 1:12001 SOUTH FREEWAY
Practice Address - Street 2:#205
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-568-0500
Practice Address - Fax:817-568-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty