Healthcare Provider Details

I. General information

NPI: 1073952479
Provider Name (Legal Business Name): AYMEN ABBAS HASAN ALDUJAILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SOUTHWEST FWY STE 1052
HOUSTON TX
77074-1813
US

IV. Provider business mailing address

450 THIS WAY ST STE B
LAKE JACKSON TX
77566-5152
US

V. Phone/Fax

Practice location:
  • Phone: 979-299-0091
  • Fax: 979-285-9430
Mailing address:
  • Phone: 979-297-2220
  • Fax: 979-297-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR6141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: