Provider Demographics
NPI:1437408556
Name:ALHADDAD, BASSAM (LP BOCP)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:
Last Name:ALHADDAD
Suffix:
Gender:M
Credentials:LP BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W HILLSIDE RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W HILLSIDE RD
Practice Address - Street 2:SUITE 25
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3196
Practice Address - Country:US
Practice Address - Phone:956-717-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11291744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6091730001Medicare NSC