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General NPI Number Information
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NPI Number | 1386089928
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Entity Type | Individual
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Provider Name | JUSTIN MCDONNELL MOHER MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 6621 FANNIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2358
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Country | US
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Telephone | 832-824-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 FANNIN ST STE A210
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City | HOUSTON
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State | TX
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Zip | 77030-2399
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Country | US
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Telephone | 860-918-1435
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Fax | 832-825-5426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 286880
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | R2418
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 286880
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD044138
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | R2418
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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