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1972509230

NPI Code Detail

MEDICARE: DR. MOHAMMAD ETMINAN M.D.

MEDICARE: DR. MOHAMMAD ETMINAN 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	L2241	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P01026731	OTHER	TX	RAILROAD MEDICARE

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
2	8M3060	OTHER	TX	BLUE CROSS AND BLUE SHIEL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3471057	OTHER	TX	AETNA HMO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	182635700	OTHER	TX	US DEPT OF LABOR
8	7095249	OTHER	TX	AETNA PPO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972509230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD ETMINAN M.D.

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR
Second Line	:	SUITE 1.100
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	281-344-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 THOMPSON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4932
Country	:	US
Telephone Number	:	281-344-1715
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/28/2012

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Directions to “ DR. MOHAMMAD ETMINAN M.D.” Practice Location

Language	Start Address	Practice Location

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