Provider Demographics
NPI:1588906465
Name:ABDELAZIZ, MUSA R (MD)
Entity type:Individual
Prefix:
First Name:MUSA
Middle Name:R
Last Name:ABDELAZIZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:305 MORRISON PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1352
Mailing Address - Country:US
Mailing Address - Phone:817-865-6800
Mailing Address - Fax:817-865-6790
Practice Address - Street 1:305 MORRISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1352
Practice Address - Country:US
Practice Address - Phone:817-865-6800
Practice Address - Fax:817-865-6790
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101261971207W00000X, 207WX0107X
DCMD044942207W00000X
390200000X
TXS6992207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588906465Medicaid