Healthcare Provider Details

I. General information

NPI: 1629022892
Provider Name (Legal Business Name): TOMMY MAOZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24433 KATY FWY
KATY TX
77494-1376
US

IV. Provider business mailing address

102 LAKESIDE OAKS DR
HOUSTON TX
77042-1033
US

V. Phone/Fax

Practice location:
  • Phone: 281-394-9111
  • Fax:
Mailing address:
  • Phone: 917-697-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08049600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberN2182
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: