Provider Demographics
NPI:1447286158
Name:ABOUGHALI, WAEL A (MD)
Entity type:Individual
Prefix:
First Name:WAEL
Middle Name:A
Last Name:ABOUGHALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:JJL 324
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7600
Mailing Address - Fax:713-500-7606
Practice Address - Street 1:1602 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4002
Practice Address - Country:US
Practice Address - Phone:281-837-2700
Practice Address - Fax:281-837-2760
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174536601Medicaid
TX82659YOtherBCBS
TX174536601Medicaid
TX8D7123Medicare PIN