Provider Demographics
NPI:1811931512
Name:ALWAN, IMAD (MD)
Entity type:Individual
Prefix:DR
First Name:IMAD
Middle Name:
Last Name:ALWAN
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 1:801 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4112
Mailing Address - Country:US
Mailing Address - Phone:830-290-6028
Mailing Address - Fax:
Practice Address - Street 1:801 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4112
Practice Address - Country:US
Practice Address - Phone:830-290-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9068207RC0000X
VA0101259539207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977029OtherTRICARE
TX8V5490OtherBCBS
TX168137102Medicaid
TX752616977073OtherTRICARE
TX752616977029OtherTRICARE
TX168137102Medicaid
TXP00349068Medicare PIN