Provider Demographics
NPI:1689246340
Name:FULL SPECTRUM MEDICAL PLLC
Entity type:Organization
Organization Name:FULL SPECTRUM MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:AWWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-348-4124
Mailing Address - Street 1:6018 TUCKERS PL
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 SATURN RD STE 201
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5351
Practice Address - Country:US
Practice Address - Phone:469-814-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty