=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891113577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUAZER AHMED M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5002 COWHORN CREEK RD
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75503-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-614-3000
-----------------------------------------------------
Fax | 903-614-3525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5002 COWHORN CREEK RD
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75503-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-614-3000
-----------------------------------------------------
Fax | 903-614-3525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | E12500
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 35125
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | S3105
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------