Basic Information
| Provider Information | |||||||||
| NPI: | 1194779892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOUR EL DEEN | ||||||||
| FirstName: | HATEM | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 GEORGE DIETER DR | ||||||||
| Address2: | STE 636 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799365692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156711371 | ||||||||
| FaxNumber: | 9152199022 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 S AUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156711371 | ||||||||
| FaxNumber: | 9152199022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N3212 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 12301 | 05 | ND | MEDICAID | 26703 | 01 | NDBCBS | OTHER | N3212 | 01 | TX | TEXAS LICENSE | OTHER | 91G41NO | 01 | MNBCBS | OTHER | 659463800 | 05 | MN | MEDICAID |