Basic Information
| Provider Information | |||||||||
| NPI: | 1114957511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHMARIAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SMITH TOWER, SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | 7137902643 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SMITH TOWER, SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | 7137902643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | F9767 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 770000927 | 01 | TX | MEDICARE 3 | OTHER | 00T79S | 01 | TX | MEDICARE1 | OTHER | 134999510 | 05 | TX | MEDICAID | 134999511 | 05 | TX | MEDICAID | P00295327 | 01 | TX | RAILROAD MEDICARE | OTHER | P01036901 | 01 | TX | RR MEDICARE | OTHER | 612341 | 01 | TX | MEDICARE 2 | OTHER | 134999509 | 05 | TX | MEDICAID | 1375250 | 05 | LA | MEDICAID | 8U8373 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |