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General NPI Number Information
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NPI Number | 1598791113
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Entity Type | Individual
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Provider Name | IMTIHAN M JAWDAT MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 8901 FM 1960 BYPASS RD W STE. 304
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City | HUMBLE
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State | TX
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Zip | 77338-4018
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Country | US
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Telephone | 713-759-9901
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Fax | 281-501-2927
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Provider Business Mailing Address
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Address Line | 2617 C W HOLCOMBE BLVD 322
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City | HOUSTON
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State | TX
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Zip | 77025-1601
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Country | US
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Telephone | 713-759-9901
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G9602
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License Number State | TX
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