Provider Demographics
NPI:1538574066
Name:ALWAZNI, MONTADHER
Entity type:Individual
Prefix:
First Name:MONTADHER
Middle Name:
Last Name:ALWAZNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 SAN ANTONIO ST APT 334
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2474
Mailing Address - Country:US
Mailing Address - Phone:432-552-8208
Mailing Address - Fax:833-811-6266
Practice Address - Street 1:4121 SAN ANTONIO ST APT 334
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2474
Practice Address - Country:US
Practice Address - Phone:432-552-8208
Practice Address - Fax:833-811-6266
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4935207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine