Provider Demographics
NPI:1316021165
Name:AL-HAMWY, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:AL-HAMWY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-3575
Mailing Address - Country:US
Mailing Address - Phone:918-348-9715
Mailing Address - Fax:
Practice Address - Street 1:3720 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2141
Practice Address - Country:US
Practice Address - Phone:918-910-5301
Practice Address - Fax:918-910-5279
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23969207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200041600AMedicaid
P00182660OtherRR MEDICARE
243435701Medicare PIN
P00182660OtherRR MEDICARE