Provider Demographics
NPI:1063407534
Name:ALSOUB, MOHAMMAD A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:ALSOUB
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CRESTVIEW PARK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2856
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1359
Practice Address - Street 1:111 HIGHWAY 70 E STE 102
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-375-1531
Practice Address - Fax:615-375-1526
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38437207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4138005OtherBLUE CROSS BLUE SHIELD TN
TN103I295563OtherMEDICARE
TN3894698Medicaid
TN6060612OtherBCBS
P00359629OtherRAILROAD MEDICARE PIN
TN1516719Medicaid
TN3894698Medicare PIN
F95136Medicare UPIN