MEDICARE: MR. ABDUL R MOOSA MD

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	207Q00000X	Family Medicine Physician	J3015	TX

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

General Provider Information

NPI Number	:	1871555052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABDUL R MOOSA MD

Provider Business Mailing Address
First Line	:	401 W FAIRMONT PKWY
Second Line	:	SUITE # D
City	:	LA PORTE
State	:	TX
Zip	:	77571-6307
Country	:	US
Telephone Number	:	281-470-4740
Fax Number	:	281-470-4733

Provider Business Practice Location Address
First Line	:	401 WEST FAIRMONT PARKWAY
Second Line	:	SUITE # D
City	:	LA PORTE
State	:	TX
Zip	:	77571-6305
Country	:	US
Telephone Number	:	281-470-4740
Fax Number	:	281-470-4733

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/20/2025

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