Healthcare Provider Details

I. General information

NPI: 1053940361
Provider Name (Legal Business Name): MOHAMAD ELZAIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S GREENVILLE AVE STE 304
RICHARDSON TX
75081-5044
US

IV. Provider business mailing address

1115 E ARKANSAS LN
ARLINGTON TX
76010-6415
US

V. Phone/Fax

Practice location:
  • Phone: 469-684-5450
  • Fax:
Mailing address:
  • Phone: 817-385-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberT8525
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: