Provider Demographics
NPI:1083797112
Name:HAMOUDI, WALID H (MD)
Entity Type:Individual
Prefix:MR
First Name:WALID
Middle Name:H
Last Name:HAMOUDI
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 1:2434 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3916
Mailing Address - Country:US
Mailing Address - Phone:409-933-4414
Mailing Address - Fax:409-933-4717
Practice Address - Street 1:2434 CEDAR DR
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3916
Practice Address - Country:US
Practice Address - Phone:409-933-4414
Practice Address - Fax:409-933-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7027208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG91197Medicare UPIN
00076QMedicare ID - Type Unspecified