Provider Demographics
NPI:1205413531
Name:AL TAWIL, JACQUES (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:AL TAWIL
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 1:7 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1781
Mailing Address - Country:US
Mailing Address - Phone:201-850-2548
Mailing Address - Fax:
Practice Address - Street 1:1200 PRESSLER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3900
Practice Address - Country:US
Practice Address - Phone:713-500-9479
Practice Address - Fax:713-500-9442
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program