Provider Demographics
NPI:1124101589
Name:BAHER ELHALWAGI, MD, PA
Entity type:Organization
Organization Name:BAHER ELHALWAGI, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELHALWAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-315-2740
Mailing Address - Street 1:1005 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2855
Mailing Address - Country:US
Mailing Address - Phone:903-315-2740
Mailing Address - Fax:903-315-2742
Practice Address - Street 1:1005 LOVERS LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2855
Practice Address - Country:US
Practice Address - Phone:903-315-2740
Practice Address - Fax:903-315-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2456207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00034MMedicare ID - Type UnspecifiedMEDICARE NUMBER