Provider Demographics
NPI:1669610051
Name:MAAMAR-TAYEB, MOKHTAR (MD)
Entity type:Individual
Prefix:
First Name:MOKHTAR
Middle Name:
Last Name:MAAMAR-TAYEB
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 1:251 WESTPARK WAY, SUITE 212
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3707
Mailing Address - Country:US
Mailing Address - Phone:214-570-2319
Mailing Address - Fax:
Practice Address - Street 1:251 WESTPARK WAY, SUITE 212
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3707
Practice Address - Country:US
Practice Address - Phone:214-570-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6467207ZP0102X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology