Healthcare Provider Details

I. General information

NPI: 1538140439
Provider Name (Legal Business Name): MOHAMAD NAWAR HAKIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-521-7415
  • Fax: 915-521-7920
Mailing address:
  • Phone: 915-545-6775
  • Fax: 915-521-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberJ6064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: