=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689101081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IMAD EL MAJZOUB M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2017
-----------------------------------------------------
Last Update Date | 05/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 PRESSLER STREET, FCT 13.5067, UNIT 1468 MD ANDERSON CANCER CENTER, DEPARTMENT OF EMERGENCY MEDI
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-792-1631
-----------------------------------------------------
Fax | 713-792-8743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 PRESSLER STREET, FCT 13.5067, UNIT 1468 MDANDERSON CANCER CENTER, DEPARTMENT OF EMERGENCY MEDIC
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-792-1631
-----------------------------------------------------
Fax | 713-792-8743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------