Provider Demographics
NPI:1437178043
Name:HAYDAR, ZIAD RAFIC
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:RAFIC
Last Name:HAYDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-6554
Mailing Address - Fax:972-272-9137
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-272-6554
Practice Address - Fax:972-272-9137
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0815207Q00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040516901Medicaid
TX040516903Medicaid
TX8AL615OtherBCBS
TX82502BMedicare PIN
TX8K9262Medicare PIN
TX040516901Medicaid