1750596904 NPI number — BARAA AL-HAFEZ M.D

Table of content: BARAA AL-HAFEZ M.D (NPI 1750596904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750596904 NPI number — BARAA AL-HAFEZ M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-HAFEZ
Provider First Name:
BARAA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1750596904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 PARK RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-242-4410
Provider Business Mailing Address Fax Number:
713-242-4412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10496 KATY FWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77043-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-571-7500
Provider Business Practice Location Address Fax Number:
713-492-2440
Provider Enumeration Date:
05/11/2007

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: 207T00000X , with the licence number:  P6764 , 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: 326733802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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