Healthcare Provider Details

I. General information

NPI: 1962674804
Provider Name (Legal Business Name): YOUSUF AHMED,MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER BLVD STE 110
CONROE TX
77304-2821
US

IV. Provider business mailing address

100 MEDICAL CENTER BLVD SUITE 110
CONROE TX
77304-2888
US

V. Phone/Fax

Practice location:
  • Phone: 936-441-7300
  • Fax: 936-760-4439
Mailing address:
  • Phone: 936-441-7300
  • Fax: 936-760-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4694
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARMEN ESTRADA
Title or Position: OFFICE MANAGER
Credential:
Phone: 936-788-4481