Provider Demographics
NPI:1578554333
Name:AL-ASSI, MOHAMMAD TAREK (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:TAREK
Last Name:AL-ASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:1001 N WALDROP DR
Practice Address - Street 2:STE. 509
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4705
Practice Address - Country:US
Practice Address - Phone:817-394-4300
Practice Address - Fax:817-394-0200
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4684207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081585402Medicaid
TX00N91FOtherBCBS GRP
TX100711404Medicaid
TX8F7165OtherBCBS
TXP00412807Medicare PIN
TX00N91FOtherBCBS GRP
TX8J8308Medicare PIN