Provider Demographics
NPI:1124018155
Name:HAIDER, MUNAWAR (MD)
Entity Type:Individual
Prefix:
First Name:MUNAWAR
Middle Name:
Last Name:HAIDER
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:PO BOX 210907
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-7907
Mailing Address - Country:US
Mailing Address - Phone:817-358-5800
Mailing Address - Fax:817-283-7686
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:STE 220
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-358-5800
Practice Address - Fax:817-283-7686
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155954401Medicaid
G88183Medicare UPIN
TX8A0282Medicare ID - Type Unspecified