Provider Demographics
NPI:1740206978
Name:HAKIM, BASHAR (MD)
Entity type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:HAKIM
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 1:126 S ANNISTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2904
Mailing Address - Country:US
Mailing Address - Phone:256-249-6050
Mailing Address - Fax:256-249-6053
Practice Address - Street 1:126 S ANNISTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2904
Practice Address - Country:US
Practice Address - Phone:256-249-6050
Practice Address - Fax:256-249-6053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHA000035148Medicaid
AL510-35148OtherBLUECROSS BLUESHIELD
ALHA000035148Medicaid
AL510-35148OtherBLUECROSS BLUESHIELD