Provider Demographics
NPI:1962496620
Name:CHOUCAIR, WASSIM KHALED (MD)
Entity Type:Individual
Prefix:
First Name:WASSIM
Middle Name:KHALED
Last Name:CHOUCAIR
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 1:8122 DATAPOINT DR
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3272
Mailing Address - Country:US
Mailing Address - Phone:210-998-6900
Mailing Address - Fax:210-998-6907
Practice Address - Street 1:8122 DATAPOINT DR
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3272
Practice Address - Country:US
Practice Address - Phone:210-998-6900
Practice Address - Fax:210-998-6907
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4299207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152809304Medicaid
TX8393B6Medicare PIN
TX360101ZNGNMedicare UPIN
TX152809304Medicaid