Provider Demographics
NPI:1518442649
Name:HADDED, ALEXANDER DE JESUS (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DE JESUS
Last Name:HADDED
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 FM 1463 RD STE 140
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4028
Mailing Address - Country:US
Mailing Address - Phone:860-301-9604
Mailing Address - Fax:
Practice Address - Street 1:6445 FM 1463 RD STE 230
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4031
Practice Address - Country:US
Practice Address - Phone:860-301-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12285363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical