Provider Demographics
NPI:1821036559
Name:AYASS, MOHAMMAD-AMMAR F (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD-AMMAR
Middle Name:F
Last Name:AYASS
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 1:223 S ABE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6305
Mailing Address - Country:US
Mailing Address - Phone:325-655-7969
Mailing Address - Fax:325-655-7976
Practice Address - Street 1:3021 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6975
Practice Address - Country:US
Practice Address - Phone:325-223-1800
Practice Address - Fax:325-223-1810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2116207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145403503Medicaid
TX168067001Medicaid
TX0027LWOtherBCBS GROUP #
TX8P5490OtherBC/BS PIN
TX0027LWOtherBCBS GROUP #
TXH18750Medicare UPIN
TX8C1728Medicare PIN