Healthcare Provider Details

I. General information

NPI: 1093820920
Provider Name (Legal Business Name): AMR MOHAMED ZAKARIA ZIDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 MID CITIES BLVD STE 100
NORTH RICHLAND HILLS TX
76182-4712
US

IV. Provider business mailing address

1220 BACKBAY DR
IRVING TX
75063-5408
US

V. Phone/Fax

Practice location:
  • Phone: 214-666-8077
  • Fax:
Mailing address:
  • Phone: 972-444-0103
  • Fax: 972-444-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK9707
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK9707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: