Healthcare Provider Details

I. General information

NPI: 1164842100
Provider Name (Legal Business Name): MOOSA MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 STONEY LAKE DR
FRIENDSWOOD TX
77546-6126
US

IV. Provider business mailing address

1515 HERITAGE DRIVE SUITE 110
MCKINNEY TX
75069
US

V. Phone/Fax

Practice location:
  • Phone: 855-860-2109
  • Fax: 855-814-8428
Mailing address:
  • Phone: 855-860-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ3015
License Number StateTX

VIII. Authorized Official

Name: ABDUL R MOOSA
Title or Position: OWNER
Credential: MD
Phone: 281-470-4740