Provider Demographics
NPI:1427252378
Name:ISLAM, ARSALLA (MD)
Entity type:Individual
Prefix:
First Name:ARSALLA
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
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:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:817-562-5905
Mailing Address - Fax:817-562-5906
Practice Address - Street 1:3100 N TARRANT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8616
Practice Address - Country:US
Practice Address - Phone:817-562-5905
Practice Address - Fax:817-562-5906
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8ER572OtherBCBS
TX196308405Medicaid
TX8ER572OtherBCBS