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General NPI Number Information
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NPI Number | 1003465915
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Entity Type | Organization
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Legal Business Name | MOAZAM PA
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 7106 SPENCER HWY
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City | PASADENA
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State | TX
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Zip | 77505-1806
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Country | US
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Telephone | 918-691-9129
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Fax |
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Provider Business Mailing Address
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Address Line | 7106 SPENCER HWY
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City | PASADENA
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State | TX
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Zip | 77505-1806
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Country | US
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Telephone | 918-691-9129
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MUSTAFA MOHAMMED MOAZAM
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Credential |
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Telephone | 918-691-9129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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