Healthcare Provider Details

I. General information

NPI: 1215108907
Provider Name (Legal Business Name): IMTIAZ AHMED MD MCPS FACP FCCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-4674
US

V. Phone/Fax

Practice location:
  • Phone: 832-632-6500
  • Fax: 580-272-0657
Mailing address:
  • Phone: 409-747-6240
  • Fax: 580-272-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberP3276
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: