Provider Demographics
NPI:1376540070
Name:AL AMIRI, ZIAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:AL AMIRI
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 1:810 LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3446
Mailing Address - Country:US
Mailing Address - Phone:903-675-6778
Mailing Address - Fax:903-675-2333
Practice Address - Street 1:810 LUCAS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3446
Practice Address - Country:US
Practice Address - Phone:903-675-6778
Practice Address - Fax:903-675-2333
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361019242085R0202X
TXH10342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361019241Medicaid
ILF19392Medicare UPIN
IL0361019241Medicaid
TXB146913Medicare PIN