1073952479 NPI number — DR. AYMEN ABBAS HASAN ALDUJAILI MD

Table of content: DR. AYMEN ABBAS HASAN ALDUJAILI MD (NPI 1073952479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073952479 NPI number — DR. AYMEN ABBAS HASAN ALDUJAILI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDUJAILI
Provider First Name:
AYMEN
Provider Middle Name:
ABBAS HASAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073952479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 THIS WAY ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE JACKSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77566-5152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-297-2220
Provider Business Mailing Address Fax Number:
979-297-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 SOUTHWEST FWY STE 1052
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-299-0091
Provider Business Practice Location Address Fax Number:
979-285-9430
Provider Enumeration Date:
06/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  R6141 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 389021202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com