Provider Demographics
NPI:1013175728
Name:AMR M. ZIDAN, M.D., P.A.
Entity Type:Organization
Organization Name:AMR M. ZIDAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-991-9950
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 E HEBRON PKWY
Practice Address - Street 2:STE 500
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4403
Practice Address - Country:US
Practice Address - Phone:972-991-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9707207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z388Medicare PIN