Healthcare Provider Details

I. General information

NPI: 1609076355
Provider Name (Legal Business Name): AMAR MAHGOUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 WORTH ST STE 950
DALLAS TX
75246-2064
US

IV. Provider business mailing address

3410 WORTH ST STE 860
DALLAS TX
75246-2064
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-8500
  • Fax:
Mailing address:
  • Phone: 214-820-8500
  • Fax: 214-820-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN3154
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberN3154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: