MEDICARE: MOHAMMAD RIDHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	V8010	TX

General Provider Information

NPI Number	:	1386223642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD RIDHA MD

Provider Business Mailing Address
First Line	:	5219 CITY BANK PKWY STE 35
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-3545
Country	:	US
Telephone Number	:	806-743-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	10175 GATEWAY BLVD W STE 140
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-283-3953
Fax Number	:	915-283-3954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	02/04/2026

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Directions to “ MOHAMMAD RIDHA MD” Practice Location

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