Provider Demographics
NPI:1902242563
Name:HARMOUCH, MANAR ALI (MD)
Entity Type:Individual
Prefix:
First Name:MANAR
Middle Name:ALI
Last Name:HARMOUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14903 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2603
Mailing Address - Country:US
Mailing Address - Phone:713-363-7640
Mailing Address - Fax:281-333-3509
Practice Address - Street 1:14903 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2603
Practice Address - Country:US
Practice Address - Phone:713-363-7640
Practice Address - Fax:281-333-3509
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361708601Medicaid
TX8FZ817OtherBCBS
TX8FZ817OtherBCBS