Healthcare Provider Details

I. General information

NPI: 1932385077
Provider Name (Legal Business Name): MAZEN ELIAS ABDALLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2008
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 S MAIN STREET SUITE 500
HOUSTON TX
77030
US

IV. Provider business mailing address

PO BOX 631607
CINCINNATI OH
45263-1607
US

V. Phone/Fax

Practice location:
  • Phone: 713-730-2229
  • Fax: 713-396-3854
Mailing address:
  • Phone: 713-300-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberP6305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: