Provider Demographics
NPI:1265433031
Name:SHOBASSY, NEZAR AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:NEZAR
Middle Name:AHMED
Last Name:SHOBASSY
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 1:2001 9TH AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2701
Mailing Address - Country:US
Mailing Address - Phone:409-983-3221
Mailing Address - Fax:409-983-3222
Practice Address - Street 1:2001 9TH AVE
Practice Address - Street 2:STE 305
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2701
Practice Address - Country:US
Practice Address - Phone:409-983-3221
Practice Address - Fax:409-983-3222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7278207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81V520OtherBC/BS
TXP01V5200Medicaid
TX826283009OtherMEDICARE RAILROAD
TX81V520OtherBC/BS
TXB26415Medicare UPIN