Provider Demographics
NPI:1417030644
Name:HAZIM, DINA
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:HAZIM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:HAZIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N WESTMORELAND RD
Practice Address - Street 2:1400 WESTMORELAND RD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1656
Practice Address - Country:US
Practice Address - Phone:214-266-4000
Practice Address - Fax:214-266-0533
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0052207R00000X
TXN1524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47370521Medicaid
TX203813504Medicaid
TX8CC650OtherBCBS
TX203813502Medicaid
TX203813503Medicaid
TX203813501Medicaid
NM341320406Medicare PIN
NM47370521Medicaid
TX203813503Medicaid