Healthcare Provider Details

I. General information

NPI: 1326294257
Provider Name (Legal Business Name): HANA ISAM ZIBDEH-LOUGH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 HESTERS CROSSING RD
ROUND ROCK TX
78681-8018
US

IV. Provider business mailing address

4515 SETON CENTER PKWY SUITE 215 - CREDENTIALING
AUSTIN TX
78759-5290
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-9024
  • Fax: 512-406-7342
Mailing address:
  • Phone: 512-231-5506
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2374
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number253154
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP7373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: