Provider Demographics
NPI:1043201650
Name:MEMON, ABDUL Q (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:Q
Last Name:MEMON
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:P O BOX 73265
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3265
Mailing Address - Country:US
Mailing Address - Phone:281-580-9030
Mailing Address - Fax:281-580-2725
Practice Address - Street 1:403 COACHMAN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6401
Practice Address - Country:US
Practice Address - Phone:713-464-6104
Practice Address - Fax:713-464-3955
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9804207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050043865OtherMEDICARE RAILROAD
TX120535302Medicaid
TX84Y621OtherBLUE CROSS BLUE SHIELD
TX120535307Medicaid
TX050043865OtherMEDICARE RAILROAD
TX120535302Medicaid
TX8L6556Medicare PIN