Provider Demographics
NPI:1942266747
Name:SAMIR AHMAD,MD,PA
Entity Type:Organization
Organization Name:SAMIR AHMAD,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:ABED
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-629-8100
Mailing Address - Street 1:1600 N LEE TREVINO DR
Mailing Address - Street 2:STE# B4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5169
Mailing Address - Country:US
Mailing Address - Phone:915-629-8100
Mailing Address - Fax:915-629-8103
Practice Address - Street 1:1600 N LEE TREVINO DR
Practice Address - Street 2:STE# B4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5169
Practice Address - Country:US
Practice Address - Phone:915-629-8100
Practice Address - Fax:915-629-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9475207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty