Provider Demographics
NPI:1063915957
Name:BUSOUL, ALI (DO)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:BUSOUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 S HULEN ST # 365
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1514
Mailing Address - Country:US
Mailing Address - Phone:817-239-3915
Mailing Address - Fax:
Practice Address - Street 1:2830 S HULEN ST # 365
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1514
Practice Address - Country:US
Practice Address - Phone:817-239-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine