Healthcare Provider Details

I. General information

NPI: 1417992744
Provider Name (Legal Business Name): QAMAR RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WESTLAKE PARK BLVD
HOUSTON TX
77079-2649
US

IV. Provider business mailing address

255 WESTLAKE PARK BLVD
HOUSTON TX
77079-2649
US

V. Phone/Fax

Practice location:
  • Phone: 281-310-5040
  • Fax:
Mailing address:
  • Phone: 281-310-5040
  • Fax: 281-310-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35070916R
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN9942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: