Provider Demographics
NPI:1649253923
Name:SALAMA, MOSTAFA M (MD)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:M
Last Name:SALAMA
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:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:2209 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8007
Practice Address - Country:US
Practice Address - Phone:830-775-1272
Practice Address - Fax:855-217-1086
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK4224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0373565-03Medicaid
TX9000790OtherAMERICAN BOARD OF GYNOCOLOGY