Provider Demographics
NPI:1376602144
Name:IMAM, ASHER S (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHER
Middle Name:S
Last Name:IMAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 STONEBRIDGE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0307
Mailing Address - Country:US
Mailing Address - Phone:817-421-2905
Mailing Address - Fax:817-431-6459
Practice Address - Street 1:175 STONEBRIDGE LN STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-0307
Practice Address - Country:US
Practice Address - Phone:817-421-2905
Practice Address - Fax:817-431-6459
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK95732084N0600X, 2084S0012X, 2084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044094302Medicaid
TX044094302Medicaid
TX89652YMedicaid