Provider Demographics
NPI:1245499136
Name:BASIOUNI, BASIOUNI (MD)
Entity type:Individual
Prefix:DR
First Name:BASIOUNI
Middle Name:
Last Name:BASIOUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BASIOUNI
Other - Middle Name:
Other - Last Name:BASIOUNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2276
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-8915
Practice Address - Street 1:801 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2276
Practice Address - Country:US
Practice Address - Phone:956-787-8915
Practice Address - Fax:956-787-2021
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1543207Q00000X, 207V00000X
DEC2-0024194207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202768203Medicaid
TX202768203Medicaid