Provider Demographics
NPI:1043300148
Name:HALLOUM, AMMAR MOHAMED-ALI (MD)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:MOHAMED-ALI
Last Name:HALLOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 VICTORIA LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7840
Mailing Address - Country:US
Mailing Address - Phone:956-428-7862
Mailing Address - Fax:956-440-0395
Practice Address - Street 1:844 CENTRAL BLVD
Practice Address - Street 2:420
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7552
Practice Address - Country:US
Practice Address - Phone:956-428-7862
Practice Address - Fax:956-440-0395
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4804207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183807002Medicaid
TX183807001Medicaid
TX8A9371OtherBLUE CROSS BLUE SHIELD
TX183807002Medicaid
TX8J1951Medicare PIN