Provider Demographics
NPI:1326683467
Name:HADDAD, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6210
Mailing Address - Country:US
Mailing Address - Phone:214-442-0055
Mailing Address - Fax:
Practice Address - Street 1:8201 PRESTON RD STE 520
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6210
Practice Address - Country:US
Practice Address - Phone:214-442-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine