Provider Demographics
NPI:1376543470
Name:DURAL, ALI T (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:T
Last Name:DURAL
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:PO BOX 130894
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0894
Mailing Address - Country:US
Mailing Address - Phone:936-321-0033
Mailing Address - Fax:936-321-0032
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:STE 150
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-0033
Practice Address - Fax:936-321-0032
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9005207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132712409Medicaid
TX8H3680OtherBLUE CROSS
TX7046365OtherAETNA
TX4901971OtherCIGNA
TX132712408Medicaid
TX5644116OtherAETNA
TX108097OtherAMERCAID
TX108097OtherAMERCAID
TX132712408Medicaid
TX5644116OtherAETNA
TX7046365OtherAETNA