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NPI Code Detail

MEDICARE: MALIK OMER ALI ELAZREG M.D.

MEDICARE: MALIK OMER ALI ELAZREG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianBP1-0024977TX

General Provider Information

NPI Number : 1700076395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALIK OMER ALI ELAZREG M.D.
Provider Business Mailing Address
First Line : 1857 PINE ST
Second Line : SUITE 100
City : ABILENE
State : TX
Zip : 79601-2429
Country : US
Telephone Number : 325-670-3073
Fax Number : 325-670-3129
Provider Business Practice Location Address
First Line : 4600 SCYENE RD
Second Line :
City : DALLAS
State : TX
Zip : 75210-2219
Country : US
Telephone Number : 214-266-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2007
Last Update Date : 07/16/2025

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