Provider Demographics
NPI:1629077458
Name:ALHROOB, ASSAD ISMAEL (MD)
Entity Type:Individual
Prefix:
First Name:ASSAD
Middle Name:ISMAEL
Last Name:ALHROOB
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 1:5506 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9902
Mailing Address - Country:US
Mailing Address - Phone:956-661-0066
Mailing Address - Fax:956-661-0071
Practice Address - Street 1:5506 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9902
Practice Address - Country:US
Practice Address - Phone:956-661-0066
Practice Address - Fax:956-661-0071
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK69802080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ397OtherBC/BS IDENTIFIER
TX165371903Medicaid