Provider Demographics
NPI:1316923808
Name:KOUSSAYER, TAREK (MD)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:KOUSSAYER
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:301 MEDIC LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5542
Practice Address - Country:US
Practice Address - Phone:281-331-6141
Practice Address - Fax:281-331-3316
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9106207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9754OtherBCBS
TX8F9754OtherBCBSTX PROV NO
TX140302441Medicaid
TX1316923808OtherTRICARE SOUTH
TX140302440Medicaid
TX140302439Medicaid
TX140302442Medicaid
TX930112804Medicare PIN
TX8916B5Medicare PIN
TX8F9754OtherBCBS
TX8915B5Medicare UPIN
TX140302441Medicaid
TX8917B5Medicare PIN
TX1316923808OtherTRICARE SOUTH
TX140302439Medicaid
TX140302442Medicaid
TX930118205Medicare PIN
TX1316923808Medicare PIN