Provider Demographics
NPI:1982695896
Name:ABOUZAHR, FADI (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:ABOUZAHR
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 1:16620 SAN PEDRO AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-614-1231
Mailing Address - Fax:210-616-0704
Practice Address - Street 1:4458 MEDICAL DR STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3748
Practice Address - Country:US
Practice Address - Phone:210-614-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7940207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170693901Medicaid
8B9532Medicare ID - Type Unspecified
H27535Medicare UPIN