Provider Demographics
NPI:1023016458
Name:AL-RIFAI, MOHAMAD S (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:S
Last Name:AL-RIFAI
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 1:321 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-893-5141
Mailing Address - Fax:903-891-4285
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-893-5141
Practice Address - Fax:903-891-4285
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL12582084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030289503Medicaid
TX8151K2OtherBLUE CROSS
OK100058120AMedicaid
TX00U28QMedicare UPIN
TX030289503Medicaid
TX8151K2Medicare ID - Type UnspecifiedMEDICARE TEXAS