Provider Demographics
NPI:1164416608
Name:AWASUM, SERGE-ALAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGE-ALAIN
Middle Name:
Last Name:AWASUM
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 1:134 VISION PARK BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3032
Mailing Address - Country:US
Mailing Address - Phone:281-205-1111
Mailing Address - Fax:281-419-2111
Practice Address - Street 1:9200 PINECROFT DR STE 480
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3285
Practice Address - Country:US
Practice Address - Phone:281-205-1111
Practice Address - Fax:281-419-2111
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282148001Medicaid
TX179142802Medicaid
TX8G1573Medicare PIN
TX282148001Medicaid
TXH66372Medicare UPIN