Provider Demographics
NPI:1841287216
Name:ALI, MAYSOON SHOCAIR (MD FACP)
Entity type:Individual
Prefix:
First Name:MAYSOON
Middle Name:SHOCAIR
Last Name:ALI
Suffix:
Gender:F
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 E MAIN ST
Mailing Address - Street 2:PO BOX 786
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1814
Mailing Address - Country:US
Mailing Address - Phone:931-296-7788
Mailing Address - Fax:931-296-7130
Practice Address - Street 1:806 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1814
Practice Address - Country:US
Practice Address - Phone:931-296-7788
Practice Address - Fax:931-296-7130
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009714207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3161144Medicaid
TN81042OtherBLUE CROSS
TN0040478OtherUNITED HEALTHCARE
B02861Medicare UPIN
TN3161144Medicare ID - Type Unspecified