Provider Demographics
NPI:1841634136
Name:HAFEZ, JAWDAT RAED (DPM)
Entity type:Individual
Prefix:
First Name:JAWDAT
Middle Name:RAED
Last Name:HAFEZ
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-5391
Mailing Address - Fax:832-632-2978
Practice Address - Street 1:600 N KOBAYASHI STE 308
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-5391
Practice Address - Fax:832-632-2978
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2194213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GA745OtherBCBS