Provider Demographics
NPI:1508338146
Name:ALI, ASEEM
Entity Type:Individual
Prefix:
First Name:ASEEM
Middle Name:
Last Name:ALI
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 1:1300 ROLLINGBROOK DR STE 508
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3863
Mailing Address - Country:US
Mailing Address - Phone:281-837-6463
Mailing Address - Fax:346-980-4054
Practice Address - Street 1:1401 LAVACA ST # 996
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1634
Practice Address - Country:US
Practice Address - Phone:504-414-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401928301Medicaid
TX8LR049OtherBCBS OF TEXAS