Provider Demographics
NPI:1891711792
Name:IMAM, QUAZI M (MD)
Entity Type:Individual
Prefix:DR
First Name:QUAZI
Middle Name:M
Last Name:IMAM
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 1:1833 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6106
Mailing Address - Country:US
Mailing Address - Phone:682-323-4566
Mailing Address - Fax:
Practice Address - Street 1:1833 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6106
Practice Address - Country:US
Practice Address - Phone:682-323-4566
Practice Address - Fax:682-323-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ38192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122129306Medicaid
TX122129306Medicaid