Basic Information
Provider Information
NPI: 1225471188
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AL-NOURI
FirstName: ZAYD
MiddleName: LUAY ABDULLAH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12545 RIATA VISTA CIR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787276524
CountryCode: US
TelephoneNumber: 5125261776
FaxNumber:  
Practice Location
Address1: 4945 WILLIAMS DR
Address2:  
City: GEORGETOWN
State: TX
PostalCode: 786332008
CountryCode: US
TelephoneNumber: 5128190500
FaxNumber: 5128190520
Other Information
ProviderEnumerationDate: 04/10/2013
LastUpdateDate: 09/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XQ6388TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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