Basic Information
| Provider Information | |||||||||
| NPI: | 1881733871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTHMAN | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CAMBRIDGE ST | ||||||||
| Address2: | SUITE 10 C | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137980950 | ||||||||
| FaxNumber: | 7137988489 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 CAMBRIDGE ST | ||||||||
| Address2: | SUITE A10.181 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137980950 | ||||||||
| FaxNumber: | 7137988489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2004-0378 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | N8054 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 002668500 | 05 | FL | MEDICAID |