Provider Demographics
NPI: | 1013190461 |
---|---|
Name: | ANSARI, MOHAMMED ZAFER (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MOHAMMED |
Middle Name: | ZAFER |
Last Name: | ANSARI |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 16126 |
Mailing Address - Street 2: | |
Mailing Address - City: | SUGAR LAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77496-6126 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-939-9447 |
Mailing Address - Fax: | 832-999-4322 |
Practice Address - Street 1: | 17189 I H 45 S STE 505 |
Practice Address - Street 2: | |
Practice Address - City: | SHENANDOAH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77385-3323 |
Practice Address - Country: | US |
Practice Address - Phone: | 936-270-4400 |
Practice Address - Fax: | 936-270-4401 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-12-07 |
Last Update Date: | 2022-07-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N7053 | 207R00000X, 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 218234705 | Medicaid | |
TX | 8FG568 | Other | BCBS |
TX | 8FG568 | Other | BCBS |