Provider Demographics
NPI:1053318857
Name:SHOUKRY, EMAD E (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:E
Last Name:SHOUKRY
Suffix:
Gender:M
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 36258
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1204
Mailing Address - Country:US
Mailing Address - Phone:251-318-2678
Mailing Address - Fax:251-405-9900
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3580
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332862207R00000X, 207RG0300X, 208M00000X
DEC10007984207RG0300X
TXQ2389207RG0300X, 208M00000X, 207R00000X
ALMD.49626208M00000X
DEC1-0007984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EV528OtherBCBS
TXP01560699OtherRAILROAD MEDICARE
TX342034101Medicaid
NV100503729Medicaid
NV39700Medicare PIN
NVI11466Medicare UPIN
TX342034101Medicaid