Provider Demographics
NPI:1417363466
Name:AL HADIDI, MOAYAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOAYAD
Middle Name:
Last Name:AL HADIDI
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 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-5458
Mailing Address - Fax:605-622-5473
Practice Address - Street 1:815 1ST AVE SE STE 104
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4602
Practice Address - Country:US
Practice Address - Phone:605-622-5458
Practice Address - Fax:605-622-5473
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD10301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program