Provider Demographics
NPI:1992748420
Name:AHDOOT, MORRIS M (MD)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:M
Last Name:AHDOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3189
Mailing Address - Country:US
Mailing Address - Phone:949-453-1173
Mailing Address - Fax:949-453-1175
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-453-1173
Practice Address - Fax:949-453-1175
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA67668207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A676680Medicaid
CA00A676680Medicaid
CAA67668Medicare ID - Type Unspecified