=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144246588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QAISER J YUSUF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2306 N ALEXANDER DR
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77520-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-837-6736
-----------------------------------------------------
Fax | 281-427-5536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2306 N ALEXANDER DR
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77520-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-837-6736
-----------------------------------------------------
Fax | 281-427-5536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | QAISER J YUSUF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-837-6736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | R29535
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------