Provider Demographics
NPI:1699003053
Name:HAIDER AFZAL MD PA
Entity Type:Organization
Organization Name:HAIDER AFZAL MD PA
Other - Org Name:BAYTOWN FAMILY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAIDER
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-428-8203
Mailing Address - Street 1:1682 WEST BAKER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-428-8203
Mailing Address - Fax:281-428-0624
Practice Address - Street 1:1682 W BAKER RD STE B
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2286
Practice Address - Country:US
Practice Address - Phone:281-428-8203
Practice Address - Fax:281-428-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297617701Medicaid
B0147692OtherDPS
B0147692OtherDPS
B0147692OtherDPS