MEDICARE: DR. MANAF A ALROUMOH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	250506	NY
2	207RN0300X	Nephrology Physician	M9796	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	258767YWN1	OTHER	TX	MEDICARE GRP MEMBER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548350614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANAF A ALROUMOH M.D.

Provider Business Mailing Address
First Line	:	450 THIS WAY ST STE B
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5152
Country	:	US
Telephone Number	:	979-297-2220
Fax Number	:	979-297-3330

Provider Business Practice Location Address
First Line	:	7777 SOUTHWEST FWY
Second Line	:	STE 1052
City	:	HOUSTON
State	:	TX
Zip	:	77074
Country	:	US
Telephone Number	:	979-299-0091
Fax Number	:	979-285-9430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/07/2021

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