Provider Demographics
NPI:1043287022
Name:MAKSOUD, ALFRED SALIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:SALIM
Last Name:MAKSOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ORCHARD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4146
Mailing Address - Country:US
Mailing Address - Phone:281-557-8555
Mailing Address - Fax:
Practice Address - Street 1:501 ORCHARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-557-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5821207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0925908OtherAETNA HMO
TX86760ZOtherRENAISSANCE
TX5622523OtherAETNA EPO-PPO
TX04733901Medicaid
TX10021308OtherAMERIGROUP
TX8A2942OtherBLUE CROSS BLUE SHIELD
TX760077790OtherGROUP TAX ID
TX86760ZOtherRENAISSANCE
TX8920K0Medicare PIN