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General NPI Number Information
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NPI Number | 1962794560
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Entity Type | Individual
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Provider Name | ALI MAZLOOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2011
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Last Update Date | 06/16/2017
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Provider Practice Location Address
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Address Line | 21216 Northwest Freeway, Suite 100
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City | Cypress
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State | TX
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Zip | 77429
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Country | US
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Telephone | 832-912-3650
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Fax | 832-912-3651
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Provider Business Mailing Address
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Address Line | 21216 Northwest Freeway, Suite 100
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City | Cypress
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State | TX
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Zip | 77429
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Country | US
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Telephone | 832-912-3650
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Fax | 832-912-3651
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology
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License Number | P9905
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License Number State | TX
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