=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326011347
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHAMED M HAQ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11950 OLD GALVESTON RD SUITE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-4856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-947-2142
-----------------------------------------------------
Fax | 832-456-6605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11950 OLD GALVESTON RD SUITE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-4856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-947-2142
-----------------------------------------------------
Fax | 832-456-6605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | F5223
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------