Provider Demographics
NPI:1043259476
Name:GHADDAR, HABIB MOHAMMAD-HUSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HABIB
Middle Name:MOHAMMAD-HUSSEIN
Last Name:GHADDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1330 E 6TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4204
Practice Address - Country:US
Practice Address - Phone:956-969-0021
Practice Address - Fax:956-698-9744
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2579207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1443OtherBLUE CROSS OF TEXAS
TX137030603Medicaid
TX137030601Medicaid
TX137030602Medicaid
TX137030605OtherCSHCN
TX137030609OtherCSHCN
TX137030606OtherCSHCN
TX137030607Medicaid