Healthcare Provider Details

I. General information

NPI: 1720249105
Provider Name (Legal Business Name): MOHAMED M ABDELMOULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 SNAKE RIVER RD STE C
KATY TX
77449-7753
US

IV. Provider business mailing address

1836 SNAKE RIVER RD STE C
KATY TX
77449-7753
US

V. Phone/Fax

Practice location:
  • Phone: 281-578-9000
  • Fax: 281-578-9004
Mailing address:
  • Phone: 832-205-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP0328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: