Provider Demographics
NPI:1184039489
Name:ALI, MAYADA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYADA
Middle Name:
Last Name:ALI
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 1:1000 GATTIS SCHOOL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2562
Mailing Address - Country:US
Mailing Address - Phone:512-649-0996
Mailing Address - Fax:512-387-3555
Practice Address - Street 1:1000 GATTIS SCHOOL RD STE 130
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2562
Practice Address - Country:US
Practice Address - Phone:512-649-0996
Practice Address - Fax:512-387-3555
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374307208Medicaid