Provider Demographics
NPI:1821371832
Name:GHALEB S AL AWAR MD PA
Entity Type:Organization
Organization Name:GHALEB S AL AWAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GHLAEB
Authorized Official - Middle Name:S
Authorized Official - Last Name:AL AWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:409-385-0556
Mailing Address - Street 1:1185 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-3619
Mailing Address - Country:US
Mailing Address - Phone:409-385-0556
Mailing Address - Fax:409-385-2031
Practice Address - Street 1:1185 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3619
Practice Address - Country:US
Practice Address - Phone:409-385-0556
Practice Address - Fax:409-385-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137191604Medicaid
TX137191609Medicaid