Provider Demographics
NPI:1265745715
Name:ABUSARA, ASHRAF (MD)
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:ABUSARA
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 1:2700 CITIZENS PLZ
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5754
Mailing Address - Country:US
Mailing Address - Phone:361-573-0756
Mailing Address - Fax:
Practice Address - Street 1:2700 CITIZENS PLZ
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5754
Practice Address - Country:US
Practice Address - Phone:361-573-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD193155207RI0011X
TXS1027207RI0011X
FLME131938207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021291500Medicaid
FLJA276ZOtherMEDICARE