Provider Demographics
NPI:1760682835
Name:MOUALLA, HAYAN (MD)
Entity Type:Individual
Prefix:
First Name:HAYAN
Middle Name:
Last Name:MOUALLA
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2121 PEASE ST STE 101
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8321
Practice Address - Country:US
Practice Address - Phone:956-425-8845
Practice Address - Fax:956-364-6785
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090767207RG0300X
VA0101248579207RH0003X
TN47337207RH0003X
TXQ6242207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I838662Medicare PIN
VAV V2224BMedicare PIN
VAV V2224AMedicare PIN
TN103I832842Medicare PIN