Provider Demographics
NPI:1649500307
Name:SALAM AL-HAFIDH MD FACP PA
Entity type:Organization
Organization Name:SALAM AL-HAFIDH MD FACP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-HAFIDH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-284-9922
Mailing Address - Street 1:7505 GLENVIEW DR STE 151
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8335
Mailing Address - Country:US
Mailing Address - Phone:817-284-9922
Mailing Address - Fax:817-284-9926
Practice Address - Street 1:7505 GLENVIEW DR STE 151
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8335
Practice Address - Country:US
Practice Address - Phone:817-284-9922
Practice Address - Fax:817-284-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044SJOtherBCBS
DP9729OtherMEDICARE RAILROAD
TX209415301Medicaid
DP9729OtherMEDICARE RAILROAD