=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235924879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTAZ ALBAHRA, MD. P.A., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 UNIVERSITY BLVD BLDG 4TH
-----------------------------------------------------
City | GALVESTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77555-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-661-1573
-----------------------------------------------------
Fax | 281-661-7569
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 W BELLFORT AVE STE 194
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-5099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-661-1573
-----------------------------------------------------
Fax | 281-661-7569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JARYD STEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-392-4976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZD0900X
-----------------------------------------------------
Taxonomy Name | Dermatopathology (Pathology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------