Provider Demographics
NPI:1871555052
Name:MOOSA, ABDUL R (MD)
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:R
Last Name:MOOSA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 W FAIRMONT PKWY
Mailing Address - Street 2:SUITE # D
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6307
Mailing Address - Country:US
Mailing Address - Phone:281-470-4740
Mailing Address - Fax:281-470-4733
Practice Address - Street 1:401 WEST FAIRMONT PARKWAY
Practice Address - Street 2:SUITE # D
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6305
Practice Address - Country:US
Practice Address - Phone:281-470-4740
Practice Address - Fax:281-470-4733
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2008-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126988802Medicaid
TX126988802Medicaid