Provider Demographics
NPI:1730416090
Name:AL-ABDULLA, ABDUL SAHIB MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:ABDUL SAHIB
Middle Name:MOHAMMED
Last Name:AL-ABDULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A. SAHIB
Other - Middle Name:M
Other - Last Name:AL-ABDULLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 847606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7606
Mailing Address - Country:US
Mailing Address - Phone:830-278-6200
Mailing Address - Fax:830-278-6202
Practice Address - Street 1:1195 GARNER FIELD RD
Practice Address - Street 2:BLDG.A, STE. 100
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4820
Practice Address - Country:US
Practice Address - Phone:830-278-6200
Practice Address - Fax:830-278-6202
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF37002085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58854Medicare UPIN