Healthcare Provider Details

I. General information

NPI: 1821371832
Provider Name (Legal Business Name): GHALEB S AL AWAR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 N 11TH ST
SILSBEE TX
77656-3619
US

IV. Provider business mailing address

1185 N 11TH ST
SILSBEE TX
77656-3619
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-0556
  • Fax: 409-385-2031
Mailing address:
  • Phone: 409-385-0556
  • Fax: 409-385-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH1730
License Number StateTX

VIII. Authorized Official

Name: DR. GHLAEB S AL AWAR
Title or Position: MD
Credential: MD PA
Phone: 409-385-0556