Provider Demographics
NPI:1083794085
Name:ALLAM, FATMA ELZAHRA M (MD)
Entity Type:Individual
Prefix:
First Name:FATMA
Middle Name:ELZAHRA M
Last Name:ALLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2476
Mailing Address - Country:US
Mailing Address - Phone:972-216-1063
Mailing Address - Fax:972-289-4559
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2476
Practice Address - Country:US
Practice Address - Phone:972-216-1063
Practice Address - Fax:972-289-4559
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00253MMedicare ID - Type Unspecified
H26670Medicare UPIN