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General NPI Number Information
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NPI Number | 1962825703
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Entity Type | Organization
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Legal Business Name | MATAGORDA FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2205 AVENUE K
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City | BAY CITY
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State | TX
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Zip | 77414-5128
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Country | US
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Telephone | 979-323-9752
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Fax | 979-323-9757
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Provider Business Mailing Address
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Address Line | PO BOX 2660
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City | BAY CITY
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State | TX
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Zip | 77404-2660
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Country | US
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Telephone | 979-323-9752
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Fax | 979-323-9757
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED DADA
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Credential | MD
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Telephone | 979-323-9752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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