Provider Demographics
NPI:1114980919
Name:ALAM, ANJUM (MD)
Entity Type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12835 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5724
Mailing Address - Country:US
Mailing Address - Phone:281-531-1600
Mailing Address - Fax:281-531-1651
Practice Address - Street 1:12835 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5724
Practice Address - Country:US
Practice Address - Phone:281-531-1600
Practice Address - Fax:281-531-1651
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5339207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
8W7100OtherBCBS
TX128180002Medicaid
TX128180006Medicaid
85262XOtherBCBS
85262XOtherBCBS
C12648Medicare UPIN
8W7100OtherBCBS