Healthcare Provider Details

I. General information

NPI: 1356962450
Provider Name (Legal Business Name): AWAD ALI S ALYAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S. COULTER STREET SUITE 1500
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 S. COULTER STREET SUITE 1500
AMARILLO TX
79106-1786
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9800
  • Fax: 806-354-5689
Mailing address:
  • Phone: 806-414-9800
  • Fax: 806-354-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036163821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: