Provider Demographics
NPI:1326294257
Name:ZIBDEH-LOUGH, HANA ISAM (DO)
Entity Type:Individual
Prefix:DR
First Name:HANA
Middle Name:ISAM
Last Name:ZIBDEH-LOUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:940 HESTERS CROSSING RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8018
Practice Address - Country:US
Practice Address - Phone:512-244-9024
Practice Address - Fax:512-406-7342
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2015-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV2374208000000X
MA253154208000000X
TXP7373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326367504OtherARC ROT MEDICAID
TX326108YKXYOtherARC ROT MEDICARE
TX326367503OtherARC TRAVIS MEDICAID
TX326108YKXVOtherARC TRAVIS MEDICARE