Provider Demographics
NPI:1528221900
Name:MOAWAD, SAMEH FAHIM (DO)
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:FAHIM
Last Name:MOAWAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1990
Mailing Address - Country:US
Mailing Address - Phone:806-472-3464
Mailing Address - Fax:
Practice Address - Street 1:6104 AVENUE Q SOUTH DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3700
Practice Address - Country:US
Practice Address - Phone:806-472-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2448207Q00000X
VA0102202612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine