Healthcare Provider Details

I. General information

NPI: 1558643593
Provider Name (Legal Business Name): MOHAMED FAHMY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

309 JACKSON ST SIX FLOOR , HOSPITALIST OFFICE
MONROE LA
71201-7407
US

V. Phone/Fax

Practice location:
  • Phone: 832-632-6500
  • Fax: 409-772-9532
Mailing address:
  • Phone: 318-966-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.207028
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU3514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: