Provider Demographics
NPI:1801100979
Name:IDRIS, OWAIS M (MD)
Entity type:Individual
Prefix:DR
First Name:OWAIS
Middle Name:M
Last Name:IDRIS
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 1:13192 DALLAS PKWY STE 610
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4248
Mailing Address - Country:US
Mailing Address - Phone:469-213-5969
Mailing Address - Fax:833-362-1209
Practice Address - Street 1:13192 DALLAS PKWY STE 610
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4248
Practice Address - Country:US
Practice Address - Phone:469-213-5969
Practice Address - Fax:833-362-1209
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35121408207RC0000X, 207R00000X
TXT2398207RC0000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1R6220OtherMEDICARE
TX1R6221OtherMEDICARE