Provider Demographics
NPI:1649531724
Name:AYUB, NADER ALI (DO)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:ALI
Last Name:AYUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8330 HIGHWAY 6
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4777
Mailing Address - Country:US
Mailing Address - Phone:281-325-4100
Mailing Address - Fax:281-325-4292
Practice Address - Street 1:8330 HIGHWAY 6
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4777
Practice Address - Country:US
Practice Address - Phone:281-325-4100
Practice Address - Fax:281-325-4292
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP9047207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FY074OtherBCBS
TX359492101Medicaid
TX359492101Medicaid