Provider Demographics
NPI:1194779892
Name:NOUR EL DEEN, HATEM AHMED (MD)
Entity type:Individual
Prefix:
First Name:HATEM
Middle Name:AHMED
Last Name:NOUR EL DEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1605 GEORGE DIETER DR
Mailing Address - Street 2:STE 636
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5692
Mailing Address - Country:US
Mailing Address - Phone:915-671-1371
Mailing Address - Fax:915-219-9022
Practice Address - Street 1:3101 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7541
Practice Address - Country:US
Practice Address - Phone:915-671-1371
Practice Address - Fax:915-219-9022
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN32122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207289401Medicaid
ND12301Medicaid
91G41NOOtherMNBCBS
26703OtherNDBCBS
MN659463800Medicaid
TXN3212OtherTEXAS LICENSE
TX8F23128Medicare PIN
TXN3212OtherTEXAS LICENSE