Healthcare Provider Details

I. General information

NPI: 1710308705
Provider Name (Legal Business Name): TAJUDDIN Q. MOMIN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7119 CRANFORD CT
SUGAR LAND TX
77479-5633
US

IV. Provider business mailing address

PO BOX 16009
SUGAR LAND TX
77496-6009
US

V. Phone/Fax

Practice location:
  • Phone: 281-416-5216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANEL MONROE
Title or Position: MANAGER
Credential:
Phone: 281-416-5216