Healthcare Provider Details

I. General information

NPI: 1396739405
Provider Name (Legal Business Name): MOHAMMAD F. AZIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST STE 300
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

17448 HIGHWAY 3 STE 200
WEBSTER TX
77598-4140
US

V. Phone/Fax

Practice location:
  • Phone: 281-604-1300
  • Fax: 281-724-0225
Mailing address:
  • Phone: 281-604-1300
  • Fax: 281-724-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ3398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: