Healthcare Provider Details

I. General information

NPI: 1235153396
Provider Name (Legal Business Name): MOHAMMED O AHMED PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S CLOSNER BLVD
EDINBURG TX
78539-4660
US

IV. Provider business mailing address

502 S CLOSNER BLVD
EDINBURG TX
78539-4660
US

V. Phone/Fax

Practice location:
  • Phone: 956-292-0100
  • Fax: 956-383-1906
Mailing address:
  • Phone: 956-292-0100
  • Fax: 956-383-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: