Healthcare Provider Details

I. General information

NPI: 1336634120
Provider Name (Legal Business Name): ABDULLAH IBRAHIM ALALWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST STE 2100
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 S COULTER ST STE 2100
AMARILLO TX
79106-1786
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9656
  • Fax: 806-354-5561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101282829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: