Provider Demographics
NPI:1871978346
Name:DAOUDI, KHEIREDDINE (LSA)
Entity type:Individual
Prefix:MR
First Name:KHEIREDDINE
Middle Name:
Last Name:DAOUDI
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77383-2207
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:18703 DUKE LAKE -DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:713-518-2153
Practice Address - Fax:832-478-9266
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00581246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant