Provider Demographics
NPI:1689995649
Name:GUIRGUIS, MEDHAT (MD)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:GUIRGUIS
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 1:103 BOB O LINK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5849
Mailing Address - Country:US
Mailing Address - Phone:806-401-1759
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STOP 8103
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-2800
Practice Address - Fax:806-743-1262
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TXP89072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program