Provider Demographics
NPI:1295734424
Name:AL KHARRAT, HOUSSAM (MD)
Entity type:Individual
Prefix:
First Name:HOUSSAM
Middle Name:
Last Name:AL KHARRAT
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 1:5115 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3017
Mailing Address - Country:US
Mailing Address - Phone:806-788-4368
Mailing Address - Fax:806-788-4369
Practice Address - Street 1:5115 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3017
Practice Address - Country:US
Practice Address - Phone:806-788-4368
Practice Address - Fax:806-788-4369
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8588207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6122Medicare PIN