Provider Demographics
NPI:1104096726
Name:ELGOUHARI, HESHAM MOHAMED (MD)
Entity type:Individual
Prefix:
First Name:HESHAM
Middle Name:MOHAMED
Last Name:ELGOUHARI
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 1:4616 S US HIGHWAY 75 STE 203
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4582
Mailing Address - Country:US
Mailing Address - Phone:903-462-6310
Mailing Address - Fax:903-462-6311
Practice Address - Street 1:4616 S US HIGHWAY 75 STE 203
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4582
Practice Address - Country:US
Practice Address - Phone:903-462-6310
Practice Address - Fax:903-462-6311
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.011317207RI0008X, 207RI0200X, 207RT0003X
SD7199207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6005870Medicaid
256150OtherMIDLAND'S CHOICE
SD6005870Medicaid