Individual
EAZ ALDEAN MOHEMD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4117 N STORY RD, IRVING, TX 75038-5904
(469) 544-7173
Mailing address
2625 CASTLE ST, IRVING, TX 75038-5807
(469) 544-7173
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343800000X
—
TX
Enumeration date
06/11/2015
Last updated
06/11/2015
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