Provider Demographics
NPI:1720280647
Name:RIZKALLA, SHERIF (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 220
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-358-5800
Practice Address - Fax:817-283-7686
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10024721207R00000X
TXN2758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01130774OtherMEDICARE RAILROAD
TX205483502Medicaid
TX205483502Medicaid