Provider Demographics
NPI:1093744393
Name:MOAYYAD, EDWARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:MOAYYAD
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 1:2624 MATLOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015
Mailing Address - Country:US
Mailing Address - Phone:817-275-8131
Mailing Address - Fax:817-795-9700
Practice Address - Street 1:2624 MATLOCK RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2525
Practice Address - Country:US
Practice Address - Phone:817-275-8131
Practice Address - Fax:817-795-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110609807Medicaid
TX110609806Medicaid
TXE77006Medicare UPIN