Provider Demographics
NPI:1972832731
Name:DERMATOLOGY SOUTHWEST
Entity Type:Organization
Organization Name:DERMATOLOGY SOUTHWEST
Other - Org Name:M. BASEM CHAKER, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:BASEM
Authorized Official - Last Name:CHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-568-0500
Mailing Address - Street 1:12001 SOUTH FWY
Mailing Address - Street 2:STE. 205
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7208
Mailing Address - Country:US
Mailing Address - Phone:817-568-0500
Mailing Address - Fax:817-568-0501
Practice Address - Street 1:12001 SOUTH FWY
Practice Address - Street 2:STE. 205
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7208
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:2009-12-08
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9018207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00532ROtherPTAN
TXE60667Medicare UPIN