Provider Demographics
NPI:1679517858
Name:AL-ALOU, FAHD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAHD
Middle Name:
Last Name:AL-ALOU
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 1:2435 S AVENUE A STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7176
Mailing Address - Country:US
Mailing Address - Phone:928-366-1026
Mailing Address - Fax:928-366-1028
Practice Address - Street 1:2435 S AVENUE A STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7176
Practice Address - Country:US
Practice Address - Phone:928-366-1026
Practice Address - Fax:928-366-1028
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45521207R00000X, 261QP2300X, 208000000X
MP0407207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ687617Medicaid