Provider Demographics
NPI:1194273664
Name:AWDALLAH, OSMAN W
Entity type:Individual
Prefix:
First Name:OSMAN
Middle Name:W
Last Name:AWDALLAH
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 1:12611 HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2607
Mailing Address - Country:US
Mailing Address - Phone:972-986-8888
Mailing Address - Fax:972-986-8400
Practice Address - Street 1:12611 HORNBEAM DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:972-986-8888
Practice Address - Fax:972-986-8400
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32061448497343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)